Some eyelash and eyebrow growth serums sold over the counter can cause the fat around the eyes to shrink, leaving a hollow upper eyelid, a review in the Journal of Cosmetic Dermatology warns. The authors say the condition is often missed and that the products are poorly labelled and regulated.
The review, by Kaufman, Dulmage and colleagues, was published online on 30 October. It summarises published evidence on prostaglandin-associated periorbitopathy, or PAP.
What PAP is
Prostaglandin analogues are eye drops used to lower eye pressure in glaucoma. Doctors noticed decades ago that they also make eyelashes longer and darker. One analogue, bimatoprost, was later approved in some countries as a prescription lash-growth treatment.
Ophthalmologists have long recognised side effects of these drugs around the eye. The review lists loss of periorbital fat, a deepened upper-eyelid sulcus, drooping of the upper lid (ptosis) and darkening of the eyelid skin. The changes can make the eye look sunken or older.
The cosmetic problem
The review’s concern is that many cosmetic lash and brow serums contain prostaglandin analogues or closely related compounds, without accurate labelling or regulatory oversight. Users may not know they are applying an active drug, and may not mention a “cosmetic” product when they see a doctor.
The authors note that dermatology-specific data are sparse and that diagnosis is often delayed.
Why it matters for aesthetic practice
A patient who notices a hollow upper lid or a deepened tear trough may seek filler. If the cause is a serum, filler treats the effect while the cause continues. Published ophthalmology reports suggest that some changes may partly improve after stopping the drug, although the degree of recovery varies.
For injectors, the review supports a simple step: ask every patient with new periorbital hollowing about lash and brow products, including what is in them.
Limitations
This is a narrative review. It contains no new patient data and does not estimate how common PAP is among cosmetic serum users. The evidence on reversibility comes mainly from glaucoma patients using prescription drops daily, which may not reflect cosmetic use.
Key takeaways
- Prostaglandin analogues in some lash and brow serums can cause periorbital fat loss, a hollow upper lid, ptosis and pigmentation.
- Many cosmetic serums are poorly labelled, so users may not know they contain an active drug.
- Before treating eye-area hollowing with filler, clinicians should ask about serum use.
Original source
- Kaufman L, … Dulmage B. Journal of Cosmetic Dermatology, online 30 Oct 2026. doi:10.1111/jocd.71254
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