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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 44

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
5.0 out of 5 stars 70 reviews

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 26 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 66 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
5.0 out of 5 stars 28 reviews

Fat or Fiction?

Facial aging is a combination of stretching and sagging of the facial tissues as well as loss of the youthful fat volume in the face. Surgically moving lax facial skin uphill without addressing the facial volume loss may create surgical results that appear pulled and unnatural. Adding fat to volume depleted areas of the face during surgery restores the volume loss and results in a more refreshed, natural appearance.

Most middle aged patients undergoing facelift surgery have some extra deposits of fat in the lower abdomen or hip areas that are useful sites to obtain fat for re-injection. The fat is harvested by gentle liposuction using a small instrument introduced through a puncture in the skin. The fat is processed and immediately re-injected into the face in micro-droplets that will survive without moving out of position.

Clinical observations have shown that the facial skin overlying the fat injection sites can slowly improve in appearance, texture and sometimes pore size. This secondary benefit is thought to be due to the presence of adult stem cells that reside with the fat that is injected. More lab studies are ongoing to prove this theory.

Braun H. Graham, MD, FACS
Sarasota Plastic Surgeon
5.0 out of 5 stars 1 review

A Lot Can Be Accomplished With Fat

     You have received lots of advice, pro and con to the idea of fillers and fat for this area. Filling can be a remarkably effective way of improving the hollow appearance to the upper eyelid, but if done by inexperienced surgeons, the result can be lumpy and irregular and difficult to correct.

     The key is to be conservative with it and use very small amounts of fat "sprayed" along the border of the bone and also using a bit more fat to support the tail of the brow and give a highlight to the sub brow skin. This can actually lift the brow as well as fill the hollow orbit. My preference is to use fat, although fillers placed with blunt cannulas can also be effective.

Treatment for sunken or hollow eyes

Fat grafts can be used safely and with great results if the fat cells being transferred are handled gently and if the recipient site is adequate to receive the fat. When people comment on "dark circles and hollowing" of their lower eyelids, they often are observing a depression between the lower eyelid and the cheek, referred to at the "tear trough". Filling of a prominent tear trough can make the person with it appear more youthful and less tired. Not all tear troughs and upper, inner cheek hollows are the same, however. If the overlying skin is loose and very thin, then the tear trough becomes very unforgiving of all fillers (including fat), which may appear lumpy or visible through the skin. In these cases of loose and thin skin, a lower blepharoplasty with possible repositioning of the orbital fat may be the better treatment option. If, in the other hand, the tear trough has tighter and thicker overlying skin, then fillers (including fat) can be used safely and with excellent results. In the upper eyelid, hollowing can be improved with fat or with the filler Restylane, especially in the area above the upper boney rim of the eye.  The key points to the correction of hollows around the eyes are, above all else, selecting the right candidate for the procedure and performing the procedure with great technical skill and precision.

Paul Fortes, MD
Houston Plastic Surgeon
4.0 out of 5 stars 7 reviews

Fat transfer around the eyes.

Facial fat transfer has great potential if done correctly.

That said, the procedure has many limitations and is not always predictable.

In general, facial fat transfer works best to give an overall volume enhancement in areas that have a substantial base of tissue in which to graft.

The areas around the eyes can be thin and have the potential of leaving irregular contours, lumpiness and other undesirable results when treated with fat grafting.

That is not to say the procedure is inappropriate.

It is a technique that requires diligence, experience and careful patient selection.

I suggest you consult with an experienced, board-certified plastic surgeon to find out your options.

Best of luck,

Mats Hagstrom, M.D.

Mats Hagstrom, MD
San Francisco Plastic Surgeon
4.5 out of 5 stars 11 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.

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.