A hooded eye is when skin from the upper lid area folds over the crease, covering it partly or entirely. Some people have it from birth and some develop it over decades, and the two are not the same problem despite looking similar. Patients frequently describe eyeshadow disappearing when they open their eyes, or feeling that their eyes look smaller and more tired than they used to.
Sam Assassa, MD is a member of the American Academy of Anti-Aging Medicine and has practiced non-surgical facial aesthetics in Los Angeles since 1995. He is board certified in Internal Medicine and has performed more than 25,000 aesthetic procedures.
Three Different Causes
Brow descent. The brow sits lower than it once did, pushing the tissue beneath it downward and crowding the eyelid. The eyelid itself may be entirely normal. This is the most common cause in patients who developed hooding over time.
Excess eyelid skin. Skin on the upper lid loses elasticity and there is genuinely more of it than the lid can accommodate, so it folds over the crease. Dermatochalasis, if you encounter the term.
Volume loss above and beside the eye. Hollowing at the temple and the outer brow removes the support the brow was resting on, letting the tail descend and the outer eye crowd.
Most patients over fifty have some combination of all three.
Hooded Versus Ptosis
Worth separating clearly, because one of these is not cosmetic.
Hooding is skin and brow position. The eyelid margin, meaning the edge where the lashes sit, is in a normal position, and the tissue above it is what is covering the eye.
Ptosis is different. The eyelid margin itself sits lower than it should, because the muscle that lifts the lid has weakened or its attachment has stretched. The eye looks half open rather than covered from above.
Ptosis is a functional problem rather than a cosmetic one, and it is treated differently. Where an eyelid has dropped noticeably, dropped recently, affects one side only, or varies through the day, evaluation by an ophthalmologist or oculoplastic surgeon is the right step rather than cosmetic treatment. Where hooding affects the upper visual field, the same applies.
What Non-Surgical Treatment Can Change
Injectable treatment repositions the brow by a few millimetres, which sounds negligible and is not, because a small change reads clearly around the eye. It opens the eye and reduces the crowding.
What it does not do is remove skin. A patient with genuinely excess upper eyelid skin will get a real but modest improvement and will still have the skin, and blepharoplasty is what addresses that.
The honest split is that brow descent responds well and excess skin does not.
How Hooded Eyes Are Treated
- Botox® brow lift relaxes the muscles pulling the brow down so the forehead can lift it, which is the most direct non-surgical option.
- Brow lift and contouring combines that with filler where support beneath the brow has been lost.
- Temple treatment restores volume at the outer brow, which lifts the tail and opens the outer eye more than patients expect.
- Surgical referral where excess skin, significant descent, or any visual field effect is present.
Regain More Youthful Eyes in Beverly Hills
Dr. Assassa will establish whether your hooding comes from brow position, skin, or volume loss, and tell you plainly if a surgical opinion would serve you better. Request a consultation or schedule your appointment online.