Droopy Lids or Bedroom Eyes?

sometimes, it's a matter of perspective

During a recent podcast interview (episode 299 of Fat Mascara), I was asked what appearance issue women seem most concerned with. Eyes, I thought without hesitation. Many of you have written to me about droopy upper lids, dark circles, and puffiness. It’s no surprise our inner aesthetic critic focuses on our eyes, the communicators of so much—the state of our health, energy level, sexual attractiveness/availability. So we find a lot there to examine and be vexed about, especially as we age.

Before I get to the beauty-related stuff, may I remind you of the magic of those workhorses on your face? How they translate light is a kind of miracle that, if you think about it too much, scrambles your brain. According to the NIH, this is what’s happening as you read these words: Light hits your retina (a sensitive layer of tissue at the back of your eye); special cells called photoreceptors turn the light into electrical signals; these electrical signals travel from your retina through the optic nerve to your brain; then your brain turns the signals into the images you see here. What the hell? I’m telling you this because focusing on the skin around your eyes is a little like complaining about Philippe Petit’s hairstyle as he tightrope-walked between the Twin Towers.

You may have noticed I’m fond of metaphors, which can sometimes soften the blow of harsh realities. So I encourage you to think of your face as prime real estate—and your eyes, a house on that unique property. What you may be noticing these days is that the roof has begun to sag; the windows are the slightest bit cloudy; and the basement is darker and—especially after a night of drinking and salty snacks—more closely resembles the foundation of a bouncy house.

But I love an old house, don’t you? And I prefer minimal remodeling because I believe history is worth preserving. On the other hand, you don’t want people peering into your windows and thinking, How tired and sad. So you’ll be glad to know there are ways to freshen up without a gut renovation. 

Starting with the roof. The skin around your eyes is thin and delicate: It produces less oil and loses moisture and elasticity more quickly than other facial skin. It’s also more prone to environmental effects (UV damage and other external insults, like rubbing). As we age, the upper lids can manifest all of this with sagging and droopiness.

First, my own bias: I love the look of heavy upper lids. They used to be called “bedroom eyes.” Remember Simone Signoret? Have you recently seen Charlotte Rampling? Sexy! Because their hooded eyes make them look as if they’ve just emerged from a delicious romp (and then maybe a delicious nap). I personally don’t understand why people don’t like this look; major complaints are that they can make your eyes look smaller and makeup application more complicated. True, opening up the eye can make you look more alert—or terrified, as we sometimes see with overdone surgery. This is just to say that if and how you want to repair your upper lids depends, as with everything, on perspective. 

If they’re heavy enough to interfere with your vision, you’ll need to visit a doctor for an upper blepharoplasty (a surgical trimming) or “bleph,” as Old Sawbones calls it. The good news, according to dermatologist Mary Lupo, is that it’s now generally considered a minor procedure. You’re treated as an out-patient and with a local anesthetic: A plastic surgeon cuts along the fold of the eyelid, removes some excess skin, muscle, and maybe fat, and sutures the cut. Done. Recovery time only lasts a couple of weeks. You may be thinking, Piece of cake! I’m thinking, Two cesareans on my face. Again, perspective.

But say your upper-lids issue is purely aesthetic; you don’t like the overhang and no photos of sexy actresses will change your mind. Lucky for you, there are non-surgical options. The first may not work for everyone, but it works for me. Around twice a year I have neuromodulator (like Botox) injections in my forehead in a way that lifts the arch of my brows just a bit, which also lifts my upper lids (just a bit). Dermatologist Estee Williams is careful not to give me a Spock look; unless you’re a Trekkie, you’ll want a doctor like Williams who’s well versed in shot placement. Lupo is also enthusiastic about this option, which she calls a non-surgical brow lift and for which she incorporates some filler. After a full analysis of how a patient moves her face as she makes various expressions, Lupo selectively injects where the result will lift or reshape the brow.

Other options include various laser and radio frequency treatments (like Fraxel and Thermage) that can tighten the skin around the eyes. When I asked whether such treatments produce a great result—a.k.a. are they worth the money—Lupo was clear: Sometimes. “There’s no way you can know in advance whether these devices are going to have a home-run result,” she says. “The only way to guarantee that is surgery.” Good results on one person do not mean the same kind of results on another. This seems like a fine thing to remember when looking at before and after photos of patients who’ve had treatments. 

Here’s a related personal anecdote. Last week I met with a former beauty editor I’m fond of. We were remembering a (not uncommon) time when we were treated on a press trip to a stay at a luxurious resort. My friend had submitted to a particularly unpleasant dermatologic treatment just before the trip, not understanding there would be downtime. Suffice it to say while we enjoyed our various luxuries, she wore a lot of scarves. That reminded her of the many free treatments we used to get—which then led us to remark on how minimal the positive results of lasers and ultrasound often were. There were some terrifically nice results: Intense pulsed light treatments reduce hyperpigmentation (dark spots) and can give a great glow, for example; but without consistent, repeated treatments and/or significant downtime, neither of us felt our results would’ve been worth the money (had we paid). There’s a mystique around devices; remember that when a doctor buys a new one, he or she must use it in order to pay for it. If you’re thinking a laser or ultrasound device is the way to go, ask the doctor how many treatments are suggested and how obvious the results will be. 

Those cloudy windows! Did you know humans are the only creatures with a prominent sclera (or the whites of the eyes)? The first time I thought about this, I couldn’t believe I’d never noticed it. An evolutionary anthropologist once told me our eyes may have evolved in this way so we could easily see where our companions are looking, which is helpful in acquiring skills like language. A white sclera indicates good health, always a bonus in the attractiveness derby, so occasional use of a vasoconstricting eye drop can give you extra points.

Take my hand as we descend into the basement, where many of us confront darkness and puffiness. Shadows under the eyes can be due to a few different factors. If you press on the dark area and it disappears, your issue is probably visible blood vessels below your (delicate) skin. If the shadow doesn’t disappear with pressure, pigmentation is a likely culprit. Or there might be a shadow because of a deep tear trough. Puffiness can be due to the accumulation of fluid around the eyes or to fat pads. There are both non-surgical and surgical solutions for these issues, but because this post is starting to feel almost as interminable as Eyes Wide Shut, I’m going to address them next week.

Till then, please put your wise old eyes to good use, and practice looking at yourself with loving awareness. 

Val Asks You

Don’t be shy! What’s your most vexing or intractable appearance issue? Send me your beauty-related questions. If I don’t have a good answer, I’ll find someone who does.