Ptosis, or drooping of the upper eyelid or brow, can affect facial aesthetics and vision. For patients who want to avoid surgery, non-invasive treatments offer an effective alternative for managing mild to moderate ptosis. Understanding these non-surgical approaches is crucial, especially as more patients seek cosmetic enhancements with minimal downtime.
Understanding Ptosis: Effects on Appearance and Eye Function
Ptosis, derived from the Greek word for “falling,” refers to the abnormal drooping of the upper eyelid (eyelid ptosis) or brow (brow ptosis). It can occur due to muscle weakness, nerve damage, or skin elasticity loss, impacting cosmetic appearance and functional vision.
For some, ptosis leads to a tired, aged look. In more severe cases, it can obstruct vision or cause eye strain and headaches. If you’re wondering what is ptosis and how it differs from general eyelid sagging, it’s important to know that true ptosis involves the dysfunction of the muscles responsible for lifting the lid or brow, not just skin laxity. Identifying the cause helps determine the best treatment approach, whether cosmetic or medical.
Common Ptosis Causes and What Leads to Eyelid Drooping
Several factors can lead to ptosis, including:
- Aging: Natural tissue laxity and muscle weakening over time.
- Neurological conditions: Diseases like myasthenia gravis can result in ptosis.
- Trauma or surgery: Eye or eyelid trauma, or complications from previous surgery.
- Congenital ptosis: A condition present from birth due to poor muscle development.
- Contact lens use or frequent rubbing: May contribute to aponeurotic ptosis.
- Botox injections: When Botox is injected too close to the levator muscle, or if it diffuses beyond the intended site.
Understanding these causes helps professionals choose the appropriate treatment, surgical or non-surgical.
When Is Ptosis Treatment Without Surgery the Right Choice?
Non-surgical ptosis treatments are best suited for patients with mild to moderate ptosis or those experiencing early signs of eyelid drooping. These treatments offer a less invasive alternative to ptosis surgery, with little to no downtime.
They are also appropriate for patients not medically eligible for surgery or those seeking cosmetic improvement without the risks and recovery time associated with traditional eyelid surgery.
Exploring Non-Surgical Treatment Options for Ptosis
Innovative, non-surgical approaches can restore a more youthful, alert appearance and sometimes even improve the field of vision. Options include:
- Botox injections.
- Thread lifting.
- Dermal fillers.
- Prescription eye drops (Upneeq®).
- Ultrasound or radiofrequency treatments.
Each method has its own benefits, risks, and ideal use cases, which we’ll examine below.
Botox for Ptosis to Gently Lift the Brows
Botox is widely known for its role in smoothing dynamic wrinkles, but it also plays a valuable role in addressing mild forms of eyelid ptosis and brow ptosis. Specifically, Botox for ptosis works by relaxing the depressor muscles that pull the brows downward, primarily the orbicularis oculi, while preserving the activity of the frontalis muscle, which naturally lifts the brows.
In cases of eyebrow ptosis, small, strategically placed injections of botulinum toxin can produce a noticeable yet subtle lifting effect, opening the eye area and improving overall symmetry. For patients with mild eyelid drooping, Botox may help by reducing tension in surrounding muscles, allowing the eyelid to lift slightly as muscle balance is restored.
Thread Lifting as a Solution for Mild Brow Ptosis
Thread lifts offer another non-surgical fix for brow drooping. This procedure uses dissolvable threads inserted beneath the skin to physically lift the brow and stimulate collagen production. The threads are typically made of biocompatible materials such as polydioxanone (PDO), which are safely absorbed by the body over time while promoting tissue remodeling.
Best suited for patients with mild ptosis, thread lifting provides immediate elevation and gradual skin tightening over several months. Though not permanent, results can last up to 12-18 months with proper care. The procedure is minimally invasive, often performed in under an hour with little to no downtime, making it an appealing option for those seeking subtle facial rejuvenation without the commitment of surgery.
Lifting the Brow Area with Dermal Fillers
Volume loss around the temples and upper face often contributes to the appearance of eyebrow ptosis. As the fat pads shrink and structural support diminishes with age, the brow can descend, creating a tired or heavy-eyed look. Injecting dermal fillers in key areas, particularly the temples, lateral brow, and upper cheek, can restore lost volume and produce a lifting effect that elevates the brow and opens up the eyes.
Hyaluronic acid-based fillers help restore contour and firmness, offering both support and subtle repositioning of soft tissue that can last from 6-24 months. This approach is especially useful when addressing ptosis of the eyelid caused by age-related volume depletion rather than muscle dysfunction.
Treating Eyelid Ptosis with Upneeq® (Oxymetazoline Eye Drops)
Upneeq® is the first FDA-approved prescription eye drop for acquired eyelid ptosis. It works by stimulating Müller’s muscle, a small involuntary eyelid muscle, resulting in an eyelid lift within minutes.
Patients apply the drop daily for a temporary, non-invasive lift that lasts 6-8 hours. This option is ideal for those not ready for ptosis surgery or who need a boost for special events.
Skin Tightening with Ultrasound or Radiofrequency Devices
Ultrasound (Ultherapy) and radiofrequency (RF) technologies heat deep skin layers to stimulate collagen, providing gradual lifting and tightening in the brow and upper eyelid area. These treatments trigger a natural regenerative response, which helps improve skin elasticity and firmness over several weeks to months.
These methods are ideal for mild sagging and work well in combination with other non-surgical ptosis treatments, such as Botox or fillers, to enhance results. They are especially suitable for patients with early signs of aging or those who are not yet candidates for surgical correction.
Duration, Risks, and Benefits of Non-Surgical Ptosis Treatments
Non-surgical treatments for ptosis offer a balance between minimal invasiveness and noticeable results, but their longevity and effectiveness vary depending on the technique used and the patient’s individual characteristics.
The benefits of non-surgical ptosis treatments are significant for the right candidates. These include reduced downtime, the absence of surgical scars, and a natural-looking lift that enhances both appearance and function. Additionally, these treatments are often repeatable and customizable to meet each patient’s goals.
However, risks still exist. Minor side effects such as bruising, swelling, and temporary redness are common, but more serious complications, like asymmetry or, in rare cases, worsening of ptosis, can occur if the treatments are not administered correctly. Proper injector training, like the Skin Tightening Training course, and patient selection are crucial to minimize these risks and ensure optimal outcomes.
Ideal Candidates for Non-Surgical Ptosis Correction
These treatments are best for patients who meet one or more of the following criteria:
- Mild to moderate ptosis.
- Good skin quality and elasticity.
- Early signs of aging.
- No underlying neurological or muscular disorders.
- A desire to avoid surgery.
- Previous surgical patients needing touch-ups.
- Realistic expectations.
- Patients seeking subtle enhancement.
- Busy professionals or public-facing individuals.
When to Refer Ptosis Patients for Surgical Intervention?
In cases of severe ptosis, congenital eyelid ptosis, or when vision is significantly impaired, ptosis repair surgery may be necessary. This is also true when non-surgical methods fail to provide sufficient lift.
Referral to an oculoplastic or facial plastic surgeon is appropriate when:
- Müller’s or levator muscles are non-functional.
- There is a history of myogenic ptosis or trauma.
- Patients want long-lasting or permanent results.
Is There a Way to Naturally Fix Ptosis?
While no natural method can permanently reverse ptosis, facial exercises may improve muscle tone slightly. However, evidence supporting their efficacy is limited, especially for moderate to severe ptosis.
Lifestyle habits, like avoiding excessive screen time, managing allergies, and reducing eye rubbing, may help prevent further drooping.
Lastly
Non-surgical ptosis treatments provide a valuable solution for patients seeking to correct drooping eyelids or brows without undergoing invasive surgery. While results vary based on severity and cause, these treatments offer low-risk, low-downtime alternatives, especially when guided by a skilled medical professional. Knowing when to treat and when to refer remains key to delivering safe and satisfying outcomes.
References:
- Mustak, H.; et al. Use of Botulinum Toxin for the Correction of Mild Ptosis. JCAD. 2018. https://jcadonline.com/botulinum-toxin-correction-mild-ptosis/
- Nestor, M.S.; et al. Botulinum toxin–induced blepharoptosis: Anatomy, etiology, prevention, and therapeutic options. Wiley. 2021. https://onlinelibrary.wiley.com/doi/10.1111/jocd.14361
- Contini, M.; et al. A Systematic Review of the Efficacy of Microfocused Ultrasound for Facial Skin Tightening. PMC. 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC9861614/
- Ajmera R. Ptosis: Droopy Eyelid Causes and Treatment. Healthline. Updated April 10, 2025. Accessed May 28, 2025. https://www.healthline.com/health/eyelid-drooping