Written by Dr Gerard Ee, MBBS (UK), MRCS (Edinburgh), Postgraduate Diploma in Practical Dermatology (Cardiff), sole author. Founder and Medical Director, The Clifford Clinic and The Clifford Surgery, Singapore. Last medically reviewed and updated September 2026.
A sagging upper eyelid can be lifted without surgery when the cause is loose skin or a thick lid. Four treatments achieve this at my clinic. AGNES RF tightens the skin around the double eyelid so that the lid lifts and the crease shows again. Secret RF, placed over the fold, reduces the bulk of a heavy, hooded lid, and AGNES with Secret RF together works especially well when the eyelids are heavy. Thermage FLX Eyes, the one treatment that is FDA-cleared for the eyelids, tightens the lid skin from the surface with no needle. HIFU lifts the brow and tightens the skin around the eye, and it complements the eyelid treatments. None of the four removes a true fold of excess skin or raises a lid margin that sits low over the pupil. Those remain operations.
Most patients who consult me about an eye lift do not have ptosis. They present with skin that has loosened over the crease, or with a lid that has always been thick and has grown heavier with age. Both respond to radiofrequency. The consultation is where I determine which of the two is present, and I say at that visit when a surgeon is needed. The full guide to droopy eyelids covers the causes in detail.
Key points
- Sagging eyelid skin over a normal lid margin is a collagen problem, and radiofrequency tightens it in one session by heating the dermis until the collagen contracts.
- AGNES RF treats loose skin around the double eyelid. Secret RF treats a thick lid. AGNES and Secret RF together treat a heavy eyelid, which is where the combination works best.
- Thermage FLX Eyes tightens the skin with no needle at all and is FDA-cleared for the upper and lower eyelids. In its 72-patient trial, 88 per cent of patients had upper eyelid tightening and 86 per cent had less hooding after one session [1].
- HIFU lifts the brow and tightens the skin around the eye. It complements all three eyelid treatments and can be performed with Thermage at the same visit.
- A true fold of excess skin and ptosis need surgery, and I refer both to The Clifford Surgery at the same address.
- The AGNES with Secret RF upper eyelid lift costs $2,500 a session before GST. Thermage FLX Eyes and HIFU are quoted at consultation.
What makes an upper eyelid sag, droop or look hooded
A lower eyelid bag is herniated fat pushing forward through a weakened septum, which is why heating the fat pad from inside reduces it. A sagging or droopy upper eyelid has more than one cause, and each cause calls for a different treatment.
- Loose eyelid skin. The skin around the double eyelid has lost its recoil and folds over the crease. This is the sagging eyelid that radiofrequency treats.
- A thick, heavy lid. The soft tissue itself is bulky and weighs the fold down, producing the hooded eyelid. Secret RF reduces it.
- A descended brow. The brow has dropped and pushes the lid down. A mild drop responds to HIFU, which lifts the brow by a millimetre or two. A brow that has dropped further needs a brow lift.
- Excess skin, dermatochalasis. A true fold of redundant skin hangs over the lashes and is removed by upper blepharoplasty.
- Ptosis. The lid margin itself sits low over the pupil because the lifting muscle is weak, and it is corrected by ptosis surgery.
The first three are treated without surgery. The last two are surgical, and I say so at the first consultation rather than after a course of treatment that cannot correct them.
Four non-surgical eye lift treatments for sagging eyelids, at a glance
| AGNES RF | Secret RF | Thermage FLX Eyes | HIFU | |
|---|---|---|---|---|
| Best for | Loose skin around the double eyelid | A thick lid, or with AGNES a heavy eyelid | Mild laxity, first signs of hooding, or where no needle is wanted | A brow that has dropped a little, loose skin around the eye, alongside any of the other three |
| How it works | Insulated W needle heats the dermis, collagen contracts and rebuilds | Insulated cannula over the fold heats and reduces bulky tissue | Monopolar RF through a 0.25 cm² eye tip heats the skin from the surface | Focused ultrasound heats points under the brow and around the eye, the support layer tightens and the brow lifts |
| Type | Minimally invasive | Minimally invasive | Non-invasive | Non-invasive |
| Anaesthetic | Numbing cream and a small local injection | Numbing cream and a small local injection | None needed | Numbing cream |
| Downtime | Two to four days of swelling, work from day two | Two to four days of swelling, work from day two | Little to none | None |
| Sessions | One, reviewed at four and eight weeks | One, second considered at review | One, repeated after a year or two | One, repeated about once a year |
| FDA status | Cleared for dermatological procedures | Cleared for dermatological procedures | Cleared for periorbital wrinkles including upper and lower eyelids | Ultherapy, a HIFU device, is FDA-cleared for brow lift. Tightan 2 is the HIFU device used here |
| Fee | $2,500 before GST, AGNES with Secret RF as one eyelid lift | Included in the $2,500 eyelid lift with AGNES | Quoted at consultation | Quoted at consultation |
AGNES with Secret RF eyelid lifting for sagging and heavy eyelids
AGNES tightens the skin around the double eyelid with its W needle passed over the dermis, so that lax skin which had begun to drape over the crease is drawn back into position. Secret RF, delivered through an insulated cannula over the upper eyelid fold, reduces the bulk of a thick lid so that the lid becomes lighter and the fold shows again. A heavy eyelid is usually both problems at once, and the two devices together work especially well on it, Secret RF on the bulk and AGNES on the skin over it, at the same visit under the same numbing. The full procedure, recovery and fee are on the AGNES with Secret RF eyelid lifting treatment page.
Thermage FLX Eyes, the FDA-cleared non-invasive eyelid lift
Thermage FLX Eyes is the choice for a patient who wants no needle near the eye. A 0.25 cm² eye tip delivers monopolar radiofrequency through the skin surface while a protective shield sits on the eye, heating the dermis in bulk while the surface is cooled. The skin of the upper lid tightens, the double eyelid fold sits higher and shows more clearly, and the lower lid smooths. Thermage FLX is FDA-cleared for the non-invasive treatment of periorbital wrinkles including the upper and lower eyelids, and it is the only treatment on this page with an eyelid-specific clearance. In the trial that led to that clearance, 72 patients had one session and were followed for six months. Upper eyelid tightening was seen in 88 per cent and a reduction in hooding in 86 per cent, with no serious adverse events [1]. Most patients achieved a modest improvement, and a smaller number a marked one. It is performed at The Clifford Clinic with little to no downtime and no anaesthetic, and one session lasts for a year or two.
HIFU for sagging eyelids, lifting the brow and the skin around the eye
The eyelid treatments above act on the lid itself. HIFU acts on what sits above it. Focused ultrasound placed under the brow and along the outer eye heats small points in the support layer beneath the skin, which contracts as it heals, and the brow lifts by a millimetre or two. When the brow rises, the skin it was pushing down onto the lid rises with it, and a lid that looked hooded opens. In the 2025 eyelid radiofrequency study the brow rose by 1.2 to 1.5 mm, and that alone changed the appearance of the lid [3]. HIFU is a complement to the eyelid treatments, not a replacement. A heavy lid still needs AGNES and Secret RF, but adding HIFU to the brow and the outer eye lifts the whole area around the eye rather than the lid alone. HIFU can be performed with Thermage FLX Eyes at the same visit, with Thermage on the lids and HIFU on the brow. I use Tightan 2 for this, with numbing cream, no downtime, and one session a year.
How to fix droopy eyelids without surgery, which treatment for which eyelid
The decision is made at consultation, on examination of the lid, and it usually rests on four questions, namely whether the skin is loose, the lid thick, or both, whether the brow has dropped, how much change is wanted, and whether a needle is acceptable. Loose skin with a clear crease beneath it is treated with AGNES. A thick lid that flattens the crease is treated with Secret RF. A heavy lid, thick and loose at once, is treated with AGNES and Secret RF together. Early laxity, or a patient who wants nothing entering the skin, is treated with Thermage FLX Eyes. A brow that has dropped a little, or a face in which the whole eye area has loosened, has HIFU added to whichever of the other treatments the lid needs. Where the upper and lower lids both need treatment, they are planned together and quoted together.
Sagging eyelids that need surgery, not radiofrequency or HIFU
Four kinds of droopy eyelid do not respond to energy treatment, and I refer them to The Clifford Surgery at the same address.
- Marked brow descent. HIFU lifts a brow by a millimetre or two. A brow that has dropped further is repositioned by a brow lift, not by tightening the lid skin beneath it.
- Dermatochalasis. A true excess of upper eyelid skin is removed by upper blepharoplasty. No energy device removes redundant skin.
- Ptosis. A lid margin that sits low over the pupil is a levator problem and a surgical one. AGNES with Secret RF, Thermage and HIFU do not work on it.
- A new crease. An eyelid without a fold needs double eyelid surgery, not radiofrequency.
Sagging eyelids and eye bags, treating the upper and lower lid together
A sagging upper lid and a bag under the lower lid often present together. The bag is fat pushing forward through a weakened septum, which AGNES reduces from inside without a cut, and both lids are treated at one visit under the same numbing. Non-surgical eye bag removal covers the lower lid in full.
What the studies show for non-surgical eyelid tightening
The Thermage eyelid trial is the largest. Seventy-two patients had one session and six months of follow-up, with upper eyelid tightening in 88 per cent and less hooding in 86 per cent, and a companion safety study showed that the 0.25 cm² tip does not injure the eye when a shield is used [1, 2]. A 2025 study treated 14 Asian subjects with a single session of monopolar radiofrequency to the upper eyelid and lateral orbit. Improvement in tightening of more than 50 per cent was reported by 73 per cent of subjects at two months and by 86 per cent at six months, with brow elevation of about 1.2 to 1.5 mm and no adverse events [3]. A 2023 study of microneedle fractional radiofrequency in 11 Korean patients reported improvement in periorbital wrinkle grade and skin elasticity [4]. The lift around the double eyelid with AGNES and the reduction of a bulky lid with Secret RF are observations from my own practice over more than a decade of using AGNES around the eye. No controlled trial has measured either, and that is stated here rather than implied otherwise.
Non-surgical eye lift cost in Singapore
The AGNES with Secret RF upper eyelid lift costs $2,500 a session, before GST, and that one fee covers both devices at the same visit. The consultation fee is waived when treatment goes ahead, and both reviews are included. Thermage FLX Eyes and HIFU are quoted at consultation. Where the upper and lower lids are treated at the same visit, the two are quoted together. The eye bag removal cost page lists every eye fee at the clinic side by side.
Why Dr Ee for sagging eyelids
I was trained on AGNES personally by Dr Gun Young Ahn, the Korean dermatologist who created it, and I have used it around the eye since 2012. AGNES with Secret RF, Thermage FLX Eyes and HIFU are all performed by me at one clinic, so the treatment is chosen on the eyelid being examined and not on the one device a clinic owns.
Sagging eyelids questions answered
Can sagging eyelids be fixed without surgery?
Sagging eyelids can be fixed without surgery when the sag is caused by loose skin, a thick lid or a brow that has dropped a little. AGNES RF tightens loose skin around the double eyelid, Secret RF reduces a thick lid, the two together treat a heavy lid, Thermage FLX Eyes tightens the lid skin with no needle, and HIFU lifts the brow. A sagging eyelid caused by excess skin, ptosis or a brow that has dropped a long way needs surgery.
What is the best eye lift treatment without surgery?
The best eye lift treatment without surgery is the one that matches the cause. AGNES with Secret RF suits loose skin and a heavy lid. Thermage FLX Eyes suits mild laxity where no needle is wanted. HIFU suits a brow that has dropped. There is no single best treatment, and a clinic that offers one treatment for every eyelid is matching the eyelid to its device rather than the device to the eyelid.
Is Thermage FDA approved for the eyelids?
Thermage FLX is FDA-cleared for the non-invasive treatment of periorbital wrinkles including the upper and lower eyelids, using a dedicated 0.25 cm² eye tip with a protective eye shield.
Does Thermage make the double eyelid fold show more?
Thermage tightens the upper lid skin, so that skin which was draping over the crease sits back and the fold shows more clearly. It does not create a fold in an eyelid that has never had one.
Does HIFU help sagging eyelids?
HIFU helps sagging eyelids from above the lid. HIFU under the brow and along the outer eye lifts the brow by a millimetre or two and tightens the skin around the eye, which opens a hooded lid. It complements AGNES, Secret RF and Thermage, and can be performed in the same visit as Thermage FLX Eyes.
Can AGNES RF lift hooded eyelids?
AGNES RF tightens the skin around the double eyelid and lifts lax lid skin, which reduces mild hooding where the skin has started to drape over the crease. Hooding caused by a descended brow or by excess skin needs a brow lift or upper blepharoplasty.
Is radiofrequency safe on the upper eyelid?
Radiofrequency is safe on the upper eyelid with insulated needles, an eye shield and conservative settings. The lid skin is thin and is treated at lower energy than the lower eyelid. Thermage uses a shield and a shallow eye tip that was tested on animal, ex vivo and human eyelids before clearance.
Do eyelid exercises, creams or home devices tighten sagging eyelids?
Eyelid exercises, creams and home devices do not tighten sagging eyelids. Exercises work the muscles, and sagging eyelid skin is a collagen problem, not a muscle one. Creams hydrate the surface. Home tightening devices are too weak to heat the dermis and are not designed for the eyelid.
Book a consultation with Dr Gerard Ee at The Clifford Clinic
Dr Gerard Ee consults and performs AGNES, Secret RF, Thermage FLX Eyes and HIFU treatment at The Clifford Clinic, 50 Raffles Place, Singapore. Consultations are by appointment. Message the clinic on WhatsApp, or call 6532 2048.
Published evidence
- Biesman BS, Baker SS, Carruthers J, Silva HL, Holloman EL. Monopolar radiofrequency treatment of human eyelids, a prospective, multicenter, efficacy trial. Lasers Surg Med. 2006;38(10):890-8. PMID 17163476.
- Biesman BS, Pope K. Monopolar radiofrequency treatment of the eyelids, a safety evaluation. Dermatol Surg. 2007;33(7):794-801. PMID 17598844.
- Suh DH, Choi JE, Lee SJ, Kim HS. Tightening of the eyelids with monopolar radiofrequency in Asians. Lasers Med Sci. 2025;40(1):530. PMID 41402632.
- Kim KE, Park JH, Seul TW, Kim IH, Ryu HJ. Periorbital skin rejuvenation of Asian skin using microneedle fractional radiofrequency. Ann Dermatol. 2023;35(5):360-366. PMID 37830418.
Dr Gerard Ee consults and performs these treatments at The Clifford Clinic, 50 Raffles Place, Singapore.
This guide is written from published research and clinical experience. It is for general education, not medical advice. Suitability, results, downtime and cost vary from person to person. Please arrange a consultation for advice specific to your eyelids.
