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Treatment for Sunken and Hollow Eyes?

I have a sunken eyes with a shortage of upper eyelid fat. It's genetic and that's what gives me a tired and elderly look. What is the best treatment for this? A fat grafting surgery? Or a fat injection? Pease help. I'm a 28 year old (female) and my problem isn't the extra upper eyelid fat as most people had but the opposite, a shortage of an upper eyelid fat.

Doctor Answers 40

Fat Grafting for the Upper Eyelid Filling Hollow Eyelids with Fat Grafting, Fat Transfer

Fat graft the upper lid?  No.  Add fat to the brow-upper lid junction?  Absolutely. This is an excellent question, and I think the wide range of answers is in part an issue of terminology.  I have attached a link to my eye area fat grafting before and after gallery so you can see what I mean.

The upper eyelid is a thin structure that normally does not contain any significant amount of subcutaneous fat.  So fat grafting of the upper eyelid itself would not produce an aesthetically pleasing result, and would in fact be quite dangerous to attempt. The area between the brow and the upper eyelid crease, on the other hand, is full of subcutaneous fat in most young people, and that fullness looks youthful.  I refer to this area as the ‘brow-upper lid junction’, and I add fat to make it fuller in the majority of patients for who I perform eye-area rejuvenation surgery. 

Take a look at the eyes of fashion models in advertisements: in most cases you actually see little to none of the upper lid.  What you see is a youthful soft tissue fullness that extends from the brow to the upper lid lashes. As we age, this fatty fullness atrophies and the brow-upper lid junction gradually becomes hollow.  The outline of the bony structures below the brow (the superior orbital rim) becomes visible, and one begins to look older, sometimes even ill, and in advanced stages even skeletal.  In some patients that I treat this appearance is inherited and they have a hollow look at their brow-upper lid junction at a young age.  It is also an appearance that some people have following an overly aggressive upper blepharoplasty, where the surgeon inappropriately removes fat from the brow-upper lid junction. 
Unfortunately, this is a result that quite a few patients get from upper blepharoplasty, and I treat a significant number of these patients who need that fatty fullness restored between their brow and upper lid. Whether hollowness at the brow-upper lid junction is something that was always present, something that has developed with aging, or something that resulted from an overly-aggressive upper blepharoplasty, fat grafting of the brow-upper lid junction can rejuvenate the eye area in a manner that is simply impossible by means of standard blepharoplasty techniques.  It does not look like ‘surgery’, and patients for whom I perform this procedure return to say that their friends and acquaintances think they look great, but they can’t quite put their finger on why.
A word of caution: this is a delicate surgery that requires a significant amount of experience with fat grafting, careful preoperative evaluation, and meticulous surgical technique.  In experienced hands a youthful and aesthetically ideal brow-upper lid contour can be achieved.  Make sure your surgeon can show you numerous photographic examples of brow-upper lid junction fat grafting. .

Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 48 reviews

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Open fat grafting is the best correction for hollow eyes

Dear Shaha,

I am sure many doctors will suggest fat injection or filler injection to correct your hollow eyes.

I strongly urge you not to have injections done into your upper eyelid. There are many very delicate structures in the upper eyelid which can be injured by a needle used for injection, and injury to the levator muscle could give you a droopy eyelid.

The safest and most effective method to plump a hollow upper eyelid, in my opinion, is an open composit fat graft.

During this procedure, I harvest a small amount of fat from around your "belly button" , make a small laser incision in the upper eyelid, and graft the fat directly into the hollow area of your upper eyelid.

This procedure works very well, has been done for many years, and will give you the best result.

Again, avoid injections in this area-it sounds so easy and simple, but the risks are not worth the possible benefit, in my opinion.

Fat on upper lids is not a great idea!

Although I have vast experience with fat transfer in the lower lids, I am not a fan of fat injections in the upper lids for your problems. The fat may make you lumpy and most importantly the excess weight can affect the muscle from working naturally. Although plastic surgeons love to provide answers for all problems, this may be a case of leaving well enough alone.

Robert M. Freund, MD
New York Plastic Surgeon
5.0 out of 5 stars 22 reviews

Fat Grafting


Fat Grafting is likely the best option for you. The synthetic products are also a possibility, however, I feel you will get the most natural result with your own fat. Just make sure you go to someone with extensive experience with fat grafting. Good luck

David Shafer, MD
New York Plastic Surgeon
5.0 out of 5 stars 62 reviews

Fat grafting is excellent for sunken eyes

This is one of the areas that fat grafting really shines. Fat harvested from another part of your body and then reinjected along the upper orbital rim can have very dramatic results. It is usually permanent and has a very high satisfaction rate. If you're not sure, try some Restylane first, it's temporary and reversible.

Robert M. Jensen, MD
Medford Plastic Surgeon
4.5 out of 5 stars 23 reviews

Fat Grafting Effective for Sunken Eyes

Fat grafting can be very helpful for treating sunken hollow eyes, whether from genetics, trauma, or previous surgery. It can be done with a fine cannula and should not require surgery, but often more than one treatment is necessary because it is important to not add too much, and generally there is about 50% retention (50% of the added volume is lost within 4 to 6 weeks). What remains after that time should be relatively permanent. This may be a good option for you. Best wishes.

Fat transfer can blend the upper eyelid appearance.

What makes an upper eyelid look youthful is a natural transition from the eyebrow to the last line.  this region, in the most pleasing eyelids, have some volume and contour.  An aged or deformed eyelid has the appearance of being sunken and hollow.  A high crease of the lid makes this look even worse.  Fat transfer, fat injection or fat grafting (all the same description) is an excellent procedure to blend this area.  This is minimally invasive and very reliable.  This is one of the most common procedures I perform here in Southern California.

Hollow upper lids

Although there are a variety of opinions on this topic, my preference is for fillers here.  They are smooth, can be reversed if you don't like them, and are a little more predictable, results-wise,  than fat or open composite fat grafting.  

Treatment for Sunken Eyes

The optimal treatment non-surgically is a hyaluronic acid filler in the infrabrow hollow area done very discreetly. It is important not to over correct. If done as an operative procedure, it can be done with autologous fat by a Board Certified Plastic Surgeon with expertise in this area.

Rod J. Rohrich, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 21 reviews

Fat Grafting to the Upper Lid

Fat grafting can be done to the upper eye hollow, but this is a finesse procedure and you need to be absolutely sure you are seeing a surgeon who has done this and who is board-certified. Very small amounts of fat are injected. Risks include nodules and blindness, so please research your surgeon. Board-certified surgeons are found on Injectibles are another option and not permanent over the long term so you can see what you think about the results without long term commitment.

Michele A. Shermak, MD
Baltimore Plastic Surgeon
5.0 out of 5 stars 28 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.