Orbital Fat Loss - What Can Be Done? I'm 49, my Eyes Look Much Older. (photo)
Doctor Answers 16
Looking at your photos, it seems that your upper eyelids are somewhat droopy [eyelid ptosis]. Furthermore, I think that you are subconsciously elevating your eyebrows to compensate for this.
Raising your eyelids [ptosis repair] will definitely help your upper eyelids become less hollow. But you should be aware that your subconscious drive to raise your eyelids may go away and unmask a mild droopy eyebrow.
I would recommend consultation with an Oculoplastics surgeon [or a Facial Plastic surgeon or General Plastic surgeon that has extensive experience with eyelid ptosis repair].
You can find an ASOPRS trained Oculoplastics surgeon near you. The link is provided below.
Eyelid Injections Instead of Surgery?
You are correct that we can very often temporize surgical rejuvenation with volumizing injections in the eyelid area. But from the pictures provided, it would seem you could have a medical condition that might require addressing first. Ptosis is a condition in which your eyelids can't be raised fully- when your upper eyelids are in a perpetual state of "half mast". My advice? Get yourself examined before anyone puts any fillers or fat into or around your eyelids. I think you'll find that ptosis repair might solve much of your distress over the appearance of your eyes. Thanks for the question! -Dr. Capone
It looks like from your photos that you have eyelid ptosis.This may make the eyes appear more hollow. Correct that first, and then see if you need fillers, etc.
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Upper eyelid ptosis with older appearance
You have upper eyelid ptosis (droopy) which causes your eyebrow to be lifted in order to assist lifting the droopy upper eyelids. That causes the upper eyelid area to be stretched and unveil the hollowness that is present with aging. So, the main treatment would be upper eyelid ptosis surgery. Filler or fat injection can be injected into the brow/upper eyelid area if necessary but that would definitely be secondary. See an oculoplastic surgeon.
Ptosis and hollow upper lids
Melody I would have to see you in person,but I think a good first step in improving your eyes would be doing a conservative upperlid bleph. with levator elevation. Any tissue harvested during the bleph. could possibly be used to make the upper lid concavity less severe. This is not saying that you still might need a filler in the upper lids.If you have fat injected in your upper lids I would suggest you see someone like Sydney Coleman M.D. the professor of fat injections.
Orbital fat loss
The pictures do show a orbital fat loss and very hollow upper lids. From the pictures is also apparent that there some ptosis present. Repairing the ptosis will reduce the aperture of the eyelid opening and help from raising the eyebrows to compensate for the ptosis. Best to seek out an oculoplastic surgeon well versed in ptosis repair and a possible small amount of fat grafting to the upper lids.
Fat depletion from eyelid areas
You do have hollowing around the eyes from loss of fat tissue support. A fat transfer or filler (done with a very experienced injector who is comfortable working in this area) is a good solution.
Before you proceed get an evaluation for the droopy upper eyelids that come from weakening of the upper eyelid "lifting" muscle, (called "ptosis") to see if you need a tightening procedure. That will also help make you look less hollow.
Good luck. I think your objectives are possible.
Combination of upper eyelid ptosis and hollowness of lower eyelids
Depending on what is truly bothering you the most, you have several options to rejuvenate your eyes. It appears as if you may have ptosis of the upper eyelids which can be treated with a fairly simple procedure and would help "brighten" your eyes. You also have hollowness under your lower eyelids which can be treated with in office injections with restylane or juvederm or autologous fat transfer. These results can last anywhere from 6 months to several years depending on the modality chosen.
Address eyelid ptosis first
Before considering fillers, please be seen by an oculoplastic surgeon (an ophthalmologist who does eyelid surgery) and have an evaluation for eyelid ptosis. That may be more of what you have than fat loss. Also, when considering fillers, you can always have a saline injection to see if you like the effect. This will go away in a few hours but the amounts and technique can be determined for you if you happen to like it and want to convert to HA's.