Droopy eyelids: what a cream can do and when it’s no longer a skin issue

SKIN OVER 40

Can a cream tighten droopy eyelids?

No, no cream lifts a drooping upper eyelid, not even one marketed with words like “lifting” or “firming”. The reason lies in the anatomy: hooded eyelids develop because the eyelid skin becomes longer and slacker over the years, because the fatty tissue beneath it shifts, or because the muscle that lifts the lid loses its hold. A cream works in the uppermost layers of the skin. It can bind moisture, support the skin barrier and make fine lines look softer. What it cannot do is make excess skin disappear or tighten a loosened muscle attachment again. The “firmer” feeling many people notice after applying an eye cream is usually a brief tightening effect from film-forming ingredients, or a plumper, better-hydrated surface. That is pleasant, but it does not change how far the lid falls over your lashes. Whether you need a separate product for the eye area at all is a different question. We have looked at whether you really need an eye cream, and the short answer is: usually not.

Why do eyelids droop more with age?

Eyelids droop more with age because several tissues give way at the same time: the skin, the connective tissue, the lid muscle and the brow above. A review in the Arquivos Brasileiros de Oftalmologia describes dermatochalasis, meaning excess eyelid skin, as surplus skin pulled downwards by gravity, often accompanied by bulging fatty tissue. The tissue itself shows fewer elastic fibres and collagen bundles that lie further apart. The same review names so-called aponeurotic ptosis as the most common cause of a true drooping lid: the muscle that lifts the lid becomes thinner, loses tension or partly detaches from where it is anchored.

On top of that, eyelid skin has very little in reserve. In measurements at 15 sites on the face, published in Plastic and Reconstructive Surgery, the upper eyelid had the thinnest skin, while the tip of the nose was 3.30 times as thick. According to the review, part of this ageing is genetic, while another part is linked to sun exposure, smoking and lifestyle. That is why daily sunscreen for your face is one of the few levers you have in your own hands, for the eyelid skin too. The lids are only part of the picture, though: if what you notice is more like sagging skin and fading firmness across your whole face, the issue is volume and contours, not the lid.

Is it the eyelid skin, the brow or the lid itself – how can you tell?

You can roughly tell whether it is the eyelid skin, the brow or the lid itself that droops by asking three questions: is your lash line visible, does your brow sit lower than it used to, and does the picture change over the course of the day? This is no substitute for an examination, but it helps you ask the right question. With excess eyelid skin, a fold of skin lies over the eyelid crease, sometimes down onto the lashes, but the lid margin itself sits where it always has. With ptosis, by contrast, the lid margin drops and covers more of the pupil. If the brow droops, it pushes the skin of the upper lid down from above, and if you gently lift the brow back to its former position with a finger, most of the hooding disappears. Two or all three causes often occur together. If the lid sinks noticeably lower as the day goes on, that is not a skincare issue but a reason to get it checked by a doctor – more on that below.

Do eye creams, eyelid tapes and eyelid exercises help with hooded eyelids?

With hooded eyelids, eye creams, eyelid tapes and eyelid exercises mainly change how the eye area looks for a few hours, not its anatomy. That is no reason to dismiss them, but it is a reason to put their promises into perspective. The best evidence exists for active ingredients against fine lines, and even there, it is about the surface of the skin. We have looked separately at which anti-wrinkle ingredients are actually proven. On the hooded lid itself, that ranking changes little.

• Eye creams: provide moisture, and some tighten briefly by leaving a film on the skin. The excess eyelid skin stays.
• Eyelid tapes or strips: lift the fold of skin mechanically for as long as they stick. On thin eyelid skin, the adhesive and frequent peeling off can cause irritation.
• Eyelid exercises and eye yoga: train the ring muscle around the eye, but there is no robust evidence for a measurably higher lid margin or less excess skin.
• Cooling or massage: can briefly ease morning puffiness, but does not lift the lid.

Face yoga and focused ultrasound devices are also marketed for hooded eyelids. They are no substitute for a medical assessment.

What can daily skincare realistically do for the eye area?

Realistically, daily skincare can make sure the thin skin of the eye area is well hydrated, less crêpey and more comfortable – no more and no less. Precisely because the skin there is so thin, dryness shows sooner, and part of what people perceive as “tired eyelids” is fine lines and dull, dry skin. We have explained separately how to tell dehydration lines around the eyes from real wrinkles. Humectants such as hyaluronic acid, barrier-related lipids such as ceramides and squalane, and a fragrance-free formula are sensible criteria here. That is exactly how The Duo of serum and cream is put together: hyaluronic acid in three molecular sizes in the serum, and ceramide NP, squalane and bakuchiol in the cream. According to the application instructions, you apply both to your face and neck; the moving eyelid itself is not covered there. A hooded lid will not get any smaller as a result. The skin around it can, however, look plumper and calmer. And if what bothers you under the eye is shadows rather than lines, it is worth looking into what causes dark circles.

When are droopy eyelids a matter for an ophthalmologist or eyelid surgery?

Droopy eyelids are a matter for an ophthalmologist as soon as they restrict your field of vision, are new and progressing quickly, or come with other symptoms. A report by the American Academy of Ophthalmology concludes that surgical correction of ptosis and excess upper eyelid skin can markedly improve vision, peripheral vision and everyday activities. As indicators of a functional benefit, it lists, among other things, a loss of the upper visual field of at least 12 degrees or 24 per cent, difficulty reading, tilting the head back, and tired, strained eyes caused by the lids. A review in Community Eye Health states that any acquired ptosis should be examined by an ophthalmologist, and names warning signs that should not wait:

1. One lid drops suddenly or noticeably within a few days.
2. It comes with double vision, or one eye is positioned differently from the other.
3. The drooping lid is accompanied by a sudden, severe headache on one side.
4. The pupil on the affected side is visibly a different size from the other.
5. The lids droop noticeably more in the evening than in the morning.

With the first three, get it checked by a doctor immediately; with the other two, promptly – not at your next routine appointment. In Switzerland, eyelid lifts, medically known as blepharoplasty, are mainly performed by ophthalmologists specialising in eyelid surgery and by plastic surgeons. Whether your health insurer pays depends on whether a functional impairment has been documented by a doctor, for example with a visual field test. A purely cosmetic correction is something you pay for yourself.

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