Acquired ptosis, or drooping of the upper eyelid, affects millions of adults and can impair both vision and appearance. Oxymetazoline 0.1% ophthalmic solution (Upneeq®) is the first FDA-approved, non-surgical therapy for acquired blepharoptosis in adults, offering rapid, temporary eyelid elevation by stimulating Müller’s muscle. All treatments at Cosmetic Injectables Center Medspa are provided by certified experts under the direct supervision of Dr. Sherly Soleiman, MD, a board-certified physician and national trainer in medical aesthetics.
What Is Acquired Ptosis?
Acquired ptosis is defined as a decrease in the upper eyelid position (MRD1 <4-5 mm), often due to age-related changes, muscle dysfunction, or nerve injury. Prevalence increases with age, affecting up to 13.5% of adults and over 20% of those above 70 years old (source). Symptoms include eyelid drooping, visual field obstruction, and cosmetic concerns.
How Does Oxymetazoline (Upneeq®) Work?
Oxymetazoline 0.1% is a selective α-adrenergic agonist. When applied as an eye drop, it contracts Müller’s muscle in the upper eyelid, resulting in rapid elevation. Clinical trials show onset within 5–15 minutes, with effects lasting up to 6 hours (FDA Summary).
Clinical Evidence: Efficacy and Safety
MRD1 and Visual Field Improvement
- Meta-Analysis (2025): Oxymetazoline improved MRD1 by 0.65 mm (95% CI: 0.44-0.86 mm) over placebo (p=0.012), with low rates of serious adverse events (PubMed).
- Pooled Phase 3 Trials: MRD1 increased by 0.96–1.16 mm at 2–14 days, with superior visual field gains (4–7 points) on the Leicester Peripheral Field Test (JAMA Ophthalmology).
- AAO Report (2025): 84% of patients showed measurable eyelid elevation, and 88% reported satisfaction (Review of Optometry).
Safety Profile
- Most adverse events are mild and transient (punctate keratitis 4%, conjunctival hyperemia 3%, dry eye 2%).
- Serious adverse events are rare (1.2% vs. 1.6% for placebo), with no mortality (FDA Summary).
- No significant changes in intraocular pressure or vital signs were observed.
Who Is a Candidate for Upneeq®?
Ideal candidates are adults with acquired, non-congenital ptosis seeking a non-surgical option. Upneeq® is especially suitable for those with mild to moderate eyelid drooping, or those who are not candidates for surgery due to medical reasons. It is also used off-label for temporary ptosis following botulinum toxin injections (ClinicalTrials.gov).
How Is Upneeq® Used?
- One drop in the affected eye(s) once daily.
- Effects begin within minutes and last up to 6 hours.
- Can be used as needed for events, daily function, or as a bridge to surgery.
Comparison: Upneeq® vs. Other Ptosis Treatments
| Treatment Option | Mechanism | Onset | Duration | Invasiveness | MRD1 Improvement | Visual Field | Safety Profile | Recovery Time | FDA Approval for Ptosis |
|---|---|---|---|---|---|---|---|---|---|
| Upneeq® (Oxymetazoline 0.1%) | α-adrenergic agonist (topical) | 5–15 min | Up to 6 hours | Non-surgical | 0.65–1.4 mm | 4–7 points | Mild, transient events | None | Yes (2020) |
| Ptosis Surgery (Blepharoplasty, Levator Repair) | Surgical correction | Immediate | Permanent | Surgical | 2–4 mm+ | 7–10 points | Surgical risks | 1–2 weeks | Yes |
| Botulinum Toxin (for select cases) | Neuromodulator injection | 3–7 days | 3–4 months | Minimally invasive | Variable | Variable | Bruising, asymmetry | None–days | No |
| Ptosis Crutch Glasses | Mechanical support | Immediate | As worn | Non-surgical | None | None | Discomfort possible | None | No |
For more on surgical and non-surgical eyelid procedures, see Eyes & Under Eyes Treatments.
Limitations and Considerations
- Upneeq® provides temporary improvement; daily use is required for ongoing effect.
- Not indicated for congenital ptosis or severe eyelid dysfunction.
- Not a substitute for surgical correction in advanced cases.
- Long-term safety beyond 6 weeks is still under study.
Patient Experience and Satisfaction
Most patients report noticeable eyelid elevation and improved field of vision within minutes. Satisfaction rates exceed 85% in clinical studies, with minimal downtime and no recovery period (AAO Report). Individual results may vary.
Role of the Certified Experts at Cosmetic Injectables Center Medspa
All Upneeq® consultations and treatments are performed by certified providers under the direct supervision of Dr. Sherly Soleiman, MD. Dr. Soleiman’s expertise as a national trainer and her commitment to safety and natural results ensure each patient receives a comprehensive assessment and personalized treatment plan. The practice’s patient-first philosophy emphasizes informed consent, privacy, and a conservative, natural approach to eyelid rejuvenation.
Related Non-Surgical Eye Rejuvenation Options
- Botox for Brow Lift
- Undereye Fillers
- Laser Skin Rejuvenation
- PDO Threads for Eyelid Support
- UPNEEQ® Eye Drops
Frequently Asked Questions
What is Upneeq®?
Upneeq® is a prescription eye drop containing oxymetazoline 0.1%, FDA-approved for temporary elevation of the upper eyelid in adults with acquired ptosis.
How quickly does Upneeq® work?
Most patients notice eyelid elevation within 5–15 minutes, with effects lasting up to 6 hours.
Is Upneeq® safe for daily use?
Clinical trials show Upneeq® is safe for daily use up to 6 weeks. Mild, temporary side effects may occur. Long-term safety is still being studied.
Can Upneeq® replace eyelid surgery?
Upneeq® is a non-surgical alternative for mild to moderate ptosis. Severe cases may still require surgical correction.
Who should not use Upneeq®?
Patients with congenital ptosis, certain eye conditions, or allergies to oxymetazoline should not use Upneeq®. A medical evaluation is required.
Are results permanent?
No. Upneeq® provides temporary improvement. Daily use is needed to maintain eyelid elevation.
Can Upneeq® help with ptosis after Botox?
Preliminary studies suggest Upneeq® may help with temporary ptosis following botulinum toxin injections.
What are the most common side effects?
Mild eye irritation, dryness, or redness may occur. Serious side effects are rare.
Is a prescription required?
Yes. Upneeq® is available by prescription only and should be used under medical supervision.
Where can I get Upneeq® in Los Angeles?
Upneeq® is available at Cosmetic Injectables Center Medspa in Sherman Oaks, serving the greater Los Angeles area.
All treatments at Cosmetic Injectables Center Medspa are performed by certified experts under the direct supervision of Dr. Sherly Soleiman, MD, board-certified physician and national trainer in medical aesthetics.