Why We Get Droopy Eyelids, Puffy Eyes, And Other Eye Problems

March 16, 2015 6:07 pm 5 Comments

Droopy eyelid (drü-pē ī-lid) n. | The border of the upper eyelid falls to a lower position than normal.

Droopy eyelids are an unfortunate part of almost everyone’s life at some point or another. However, just because you have droopy eyelids, doesn’t mean you have to suffer forever. Continue reading to learn the different causes of droopy eyelids and the surgical and noninvasive treatments that you might want to consider if you are ready to say adios to your droopy eyelids.


Why do we get droopy eyelids? There are a few different factors that can cause one to have droopy eyelids.


An unwelcome side effect of the aging process is a decrease in the production of elastin and collagen.

Elastin is what makes our skin snap back in place after being stretched. As we get older, we produce less elastin which leads to the skin not being able to stretch back into place as easily as when we are younger.

Collagen is what provides the rigid platform that our skin rests on. We also produce less collagen as we age, so as we lose that rigidity, the skin tends to wrinkle and cave. This is especially true of the thin, delicate upper and lower eyelid skin. This thin skin is why the eyes, and eyelids in particular, are the first areas on our faces to show age.


Ptosis is when your upper eyelids are actually droopy. In other words the part of your eyelid with the lashes sits too low when your eyes are open. That is due to a problem with the muscles or nerves that open the eye (usually the muscles)


Dermatochalasis is when you have extra skin & or fat around the eyes. It can be extra skin hanging over your upper eyelids or sagging skin and fat on your lower eyelids.

Fat Prolapse

Fat prolapse is what people call bags. Usually people think of this as a lower lid problem, but some people have fat prolapse or excess fat in their upper eyelids as well. The thin membranes that hold the natural eyelid fat in place thin out, which can cause fat prolapse, and then gravity causes the fat to sag.

Excessive Rubbing

Excessive rubbing of the eyes and eyelids can cause the muscles and skin of the eyelid to stretch out, and repeated rubbing does not allow for the eyelids to return to their original shape.

Ocular Allergies

Seasonal or environmental allergies can cause puffy or droopy eyelids by attracting and holding on to fluid in the skin.

Eating Salty Foods

In some patients, eating salty food like Chinese food, sushi, soups, or pizza can lead the skin to hold on to fluid, causing or exacerbating puffy or droopy upper eyelids.

Genetic predisposition

In some patients, there seems to be a correlation between parents or grandparents having puffy or droopy eyelids and the patient having puffy or droopy eyelids.


Droopiness can occur in both the upper eyelids and under eye area. Sometimes, the eyelids become asymmetric with one side being droopier than the other. Asymmetry can occur due to the aging process, or in younger patients, it can be congenital.

Droopiness of the lower eyelids are commonly referred to as bags (puffiness) and/or under eye darkness. Under eye bags are most commonly caused by fat prolapse (fat in the under eye region) or allergies causing the skin to hold on to excess fluid. Under eye darkness, or dark circles are sometimes caused by a shadow being casted upon the skin. Think of this as a valley next to a hill. When the sun is shining from the opposite side, the valley is in the dark.

Darkness can also be caused by excess pigmentation in the skin, which is usually caused by chronic allergies and swelling. Excess pigmentation can be, and is often made worse by, exposure to UV light (the sun) and not wearing proper sunblock.

As the symptoms progress (the bags get puffier and/or the darkness worsens), these things can become more noticeable, and in turn cause other issues to be noticed. Due to the placement of fat pads in the under eye/cheekbone area, if the bags get puffier, they can exacerbate hollowness and darkness in the “tear trough” area (the area that runs diagonally from the corner of your eye down parallel to the nose) that occurs naturally with age. When the fat pads under the eyes thin, this can cause tear trough hollows, which then cause those areas to sink in and droop (remember about collagen and elastin?).

The good news is, all of the things discussed – droopy or puffy eyelids, excess pigmentation under the eyes, tear trough hollows – can all be fixed.

Surgical Treatments

If you suffer with severely droopy eyelids, you may want to consider cosmetic eyelid surgery, otherwise known as blepharoplasty. We perform three different types of eyelid surgery, upper eyelid surgery, lower eyelid surgery and eye bag surgery.

Upper Eyelid Surgery

Also known as upper blepharoplasty or eyelift surgery, upper eyelid surgery can correct droopiness of the upper eyelid problems and restore the contours of the face.

Lower Eyelid Surgery

Also known as lower blepharoplasty, lower eyelid surgery is specifically designed to address puffiness, drooping and, in many cases, bags in the lower eyelids.

Eye Bag Surgery

By removing your bags, eye bag surgery restores the smooth contours that made your face look youthful and energetic when you were younger.


To determine which procedure is right for you, schedule a consultation with Drs. Cohen and Swartz, so they can curate the best plan for you.

At the offices of Drs. Cohen and Swartz, we use a CO2 laser to contour the eyelids, which offers the most precise results and the quickest recuperation time. To learn more about eyelid procedure, please visit our Eyelid Surgery page.

Noninvasive Treatments

While some cases of droopy eyes are severe enough that they warrant surgery. Other cases can be solved, or greatly improved with noninvasive treatments such as Botox and dermal fillers.


Botox truly started a revolution in cosmetic surgery. Botox can be used to raise the brow and, in turn, raise droopy eyelids due to the sagging eyebrow muscles. Botox can help fix sagging upper eyelids by relaxing the muscles that pull down on your brows when your face is at rest.

Once Botox is administered, your brows are free to rise slightly to a more aesthetically-pleasing position, lifting your sagging eyelid skin with them. When brows sit higher, they naturally raise the sagging skin hanging over a patient’s eyes.

How well this treatment works depends on how much hooding a patient is experiencing, as well as the amount that the brows can be lifted.

Botox treatments are fast and easy. There’s no downtime for this procedure. While some people see immediate results from Botox, it can take up to two weeks to see the full effect.

To learn more about Botox, please read our “Is Botox Right For Me?” Blog.

Dermal Fillers

Often brows become droopy because of a loss of fat underneath your brow. In those cases, a filler such as Restylane or Juvederm is the best treatment. This gives eyelids the natural fullness they once had, which then lifts the eyelids slightly and makes them look more like they did when you were younger.

These safe and popular fillers usually last about 9-12 months; all while helping your skin build collagen and elastin. Treatments take about 15 minutes to administer, and you will see immediate results with minimal to no recovery time.

Restylane And Restylane Defyne

Restylane is an FDA approved dermal filler used to give the face youthful contours. It was the first hyaluronic acid filler approved for cosmetic use in the U.S. in 2003, and it has been successfully used in millions of treatments across the world.


Juvederm is also a crystal-clear injectable gel composed of hyaluronic acid, which is a “water-loving” molecule found naturally in the human body. Hyaluronic acid keeps skin full and hydrated.
These treatments are always performed personally by Dr. Marc Cohen or Dr. Nancy Swartz, never a nurse or assistant. When you leave our office, often, no one can tell that you’ve just had the procedure done. The problem areas treated will gradually improve within a few days. However, you should wait a full two weeks to be sure that you have obtained the full result.

To learn more about dermal fillers, please read our Dermal Fillers Blog.


Some things are easier to fix than others, but a consultation with your cosmetic surgeon can get you started on the right path. Whether you are in need of a good skin care regimen to alleviate and prevent excess pigmentation, want a dermal filler product to give you back the youthful look that you once had, or are considering eyelid surgery to get rid of those pesky bags, your visit is custom-tailored with realistic expectations between you and your doctor.

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