“Hooded” is one word for three different problems.

The finger test is the one the specialists use before the ruler (StatPearls on brow ptosis): the brow held or lifted removes the brow's contribution and shows what the lid does on its own. Add the flash photograph with the brow held — margin 4–5 mm above the reflection is normal, under about 2.5 is ptosis (StatPearls on ptosis) — and the four types sort themselves. A brow problem gets the brow ladder, a skin problem the excision, a margin problem the drop and the tendon repair, a hollow the filler; and a surgeon who does not do the finger test in the consultation is a surgeon to leave.

Toxin lowers what the relaxed muscle was holding up and raises what it was pulling down. Relax the frontalis in a face that was using it to keep hooded lids open and both brow and lid come down — the labelled 2% each (prescribing information), concentrated in exactly this face. Relax the depressors instead and the brow tail rises, 4.83 mm from the lateral canthus in the measured series and 0.6–2.1 mm in the randomised trial (temporal brow-lift study; brow-height RCT). The forehead-lines guide has the eyelid test that predicts which foreheads should be left alone.

The two phase 3 trials and the pooled analysis give the size: 1.16 mm at day 14 against 0.50 on placebo, onset within five to fifteen minutes, holding through day 42, with the visual-field endpoint met and adverse events no more frequent than placebo (pooled phase 3 analysis); the systematic review pools 1.40 mm across 458 people (oxymetazoline systematic review). A millimetre on a lid that sits at 2 mm is the difference between a sleepy eye and an ordinary one; on a fold of skin it is invisible. The drop is a daily habit with a monthly cost, works while it is in the eye, and is the cheapest way to find out whether your problem is the margin at all.

The blepharoplasty's result is measured in the decade: the fold removed does not regrow, and what returns is the ageing of what was left and, above all, the brow — which is why the browpexy studies exist, holding 2–3 mm at 24 months where blepharoplasty alone left it about half a millimetre higher, a change too small to be significant (browpexy comparison). Brow lifts are sustained one to six years in the meta-analysis with lateral relapse of 2–3 mm in some series (brow-lift meta-analysis); ptosis repair is revised in 2.6–7.7% in the randomised trial and in 1–18%, by operation, in a 272-procedure series (ptosis-repair RCT; 272-procedure series). The devices are the ones repeated yearly.

The frontalis lifts hooded lids all day, and the trial that measured it found its electrical activity at a full brow raise halved a year after skin-only lid surgery, though not after skin-and-muscle surgery, with headaches better and the brows lower in both arms (headache trial); the functional review lists fewer headaches among the consistent gains (functional outcomes review). The dynamic lines soften as the muscle relaxes; the static grooves it etched over years are the forehead-lines guide's problem, and toxin for them becomes safe only once the lids no longer need the forehead.

Hooding and ptosis remove the top of the visual field, and the functional review lists an enlarged visual field, better vision-related quality of life and fewer headaches after surgery (functional outcomes review); the oxymetazoline trials used a superior visual-field test as their primary endpoint for the same reason (pooled phase 3 analysis). Most health systems that fund eyelid surgery ask for a visual-field test with and without the lid taped up, a margin measurement and photographs; the thresholds vary by country and insurer, and an oculoplastic surgeon knows the local ones. The cosmetic version of the same operation differs only in who pays.

Sort by type first. The margin has a drug with trials (pooled phase 3 analysis); the brow has toxin at the tail (temporal brow-lift study) and ultrasound at about two millimetres (ultrasound brow study); the skin has radiofrequency at up to a quarter of a fold in most (radiofrequency eyelid trial). Anyone promising a non-surgical blepharoplasty is describing one of those three with adjectives, or a plasma pen.

The blepharoplasty incision sits in the lid crease and is hidden by the fold when the eye is open; the technique trial compared scarring between skin-only and skin-and-muscle operations and found no difference, with satisfaction rising over the year (technique trial). Müller's-muscle resection is done from the inside of the lid with no skin incision (ptosis-repair RCT), and the internal browpexy uses the blepharoplasty's incision. The endoscopic brow lift hides in the hair and pays in scalp numbness and, sometimes, hair loss along the incisions (StatPearls on endoscopic brow lift).

The self-checks are free and the pencil costs tens of euros; the toxin brow lift and the drops cost a few hundred euros a season for a few millimetres that last as long as the drug; the devices cost the same or more for a year of one to two millimetres; and the operations, at a few thousand euros once, are the only rungs that move a fold, a margin or a brow by the amount most hooded eyes need. Prices are typical Western European ranges and vary by city, surgeon and whether the lid, the brow and the tendon are done in one sitting, which is cheaper than three.

Most ptosis after fifty is a stretched tendon, and the specialist reviews exist because some is not. The evaluation review lists the masquerades — a third-nerve palsy, which can be the first sign of an aneurysm and comes with a large pupil, double vision or an eye that cannot move; Horner's syndrome, a mild ptosis with a small pupil that can signal a carotid dissection or a tumour at the lung apex; myasthenia gravis, a ptosis that worsens through the day and with fatigue and comes with double vision or weakness — and insists on excluding them before any cosmetic plan (ptosis evaluation review; StatPearls on ptosis). The British survey found one probable myasthenia among its 46 ptoses and eleven mechanical causes — lumps and swellings weighing the lid down (British ptosis survey). The rules: sudden means emergency; variable means neurology; a pupil that does not match its partner means a doctor today; and a lid that drooped after a head injury, an eye operation or a new medication is a question for the doctor who treated you, or who prescribed the medicine, before it is a question for a surgeon.

The eyelid's one dangerous complication is bleeding into the closed space behind the eye: in the survey of 269,433 cosmetic eyelid operations there were 149 orbital haemorrhages, 48 with temporary and 12 with permanent visual loss, most within the first three hours and the risk falling sharply after 24, with hypertension, perioperative aspirin, postoperative vomiting and early physical activity the common companions (orbital haemorrhage survey) — which is why blood pressure is controlled, blood thinners are discussed, and sudden severe pain or a bulging eye in the first day is a return to the surgeon that hour, not a phone call in the morning. The aesthetic complications are the irreversible ones: skin over-resected leaves a lid that cannot close, dries the eye and hollows the socket, and the complication reviews put prevention — measuring what to leave rather than what to take — ahead of any repair (blepharoplasty complications review). In a 272-procedure series, 5.5% of ptosis repairs needed a second operation for residual ptosis, 18% of those done by the external route alone, and 1.4% were over-corrected (272-procedure series); brow lifts leave scalp numbness, asymmetry and hair loss along the incisions and relapse laterally (StatPearls on endoscopic brow lift). The trade that protects you is the specialist: an oculoplastic or facial plastic surgeon who measures margins, tests the drop, and operates on eyes weekly.

The forehead label's 2% eyelid ptosis and 2% brow ptosis against 0% on placebo are averages over foreheads that could afford to relax (prescribing information); in a face whose brows sit on the rim and whose lids are hooded, the frontalis is load-bearing, and the complication reviews single out low brows, hooded lids and a working forehead as the predictors of heaviness that lasts the life of the toxin (complications review). True lid ptosis, from toxin diffusing to the levator after glabellar or crow's-foot injections, is the most frequent clinically significant complication in the 2026 review and is managed with alpha-adrenergic drops — apraclonidine 0.5%, or oxymetazoline 0.1% where available — that contract Müller's muscle and lift the lid 1–3 mm while the droop wears off, within two to four weeks in most reports and up to about three months in some (toxin complications review; apraclonidine report). The rules for this face: the brow lift is depressors only; the frontalis is injected only if the forehead-lines guide's eyelid test passes, and then in small doses high on the forehead; and a drooped lid is reported to the injector the day it appears, not endured for a season.

Every energy device on this page sits a few millimetres from the eye. Radiofrequency on the lid is delivered over a protective contact lens and the multicentre trial found no serious event in 72 patients (radiofrequency eyelid trial); focused ultrasound is kept off the orbital rim by operators trained to shield it; and the plasma pen, in unregulated copies used at home and in salons, has produced pigment scars on lid skin, and the numbing cream applied before one salon treatment a published bilateral chemical eye injury (eye-injury case report). Filler in the hollow above the lid sits among the supraorbital and supratrochlear arteries, whose connections to the ophthalmic circulation make the upper orbit one of the highest-risk zones for filler blindness, and the periocular review sets out the vascular events, the lumps and the bluish show of gel placed too shallow (periocular filler review). The rules: no device on the lid without eye protection; no filler above the lid from anyone who does not treat that zone weekly with hyaluronidase in the room; and pain, blanching, a visual change or a blue tinge in the hours after is an emergency, not a wait-and-see.