Blepharoplasty Revisions for Hollow Upper Eyelids

After Blepharoplasty surgery creating hollow upper eyeslids. What is the best repair option for hollow eyelids. Pearl fat grafting or fat transfer? What is the risks and benefit's of each options? How long after the initial surgery should you wait for the revisions?

Doctor Answers 7

Hollow eyelids- correction with fat grafting - View Photos

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Many of my brow-upper lid junction structural fat grafting patients have come to my practice for the correction of hollowness created by the over-zealous removal of fat during an upper blepharoplasty surgery. I am continually amazed at how many cosmetic surgeons practice 1970's-era blepharoplasty surgery in the 21st century. I almost never remove upper lid fat during blepharoplasty surgery, and in many cases I actually add fat at the brow-upper lid junction. Fortunately, essentially all cases of post-blepharoplasty hollowness can be improved dramatically by structural fat grafting. It is a more challenging procedure, as scar tissue must be overcome to create space for the grafted fat, and in many cases it takes more than one fat grafting procedure to restore adequate fullness in these patients.
Lower lid hollowness following an overly aggressive lower blepharoplasty can likewise be improved. One must exercise care and caution, as lower lid skin and the underlying soft tissues are usually quite thin, and thus the lower lids are less able to conceal grafted fat. Fat grafting must be preformed conservatively here, with a plan for secondary and occasionally tertiary fat grafting procedures depending on the 'take' of the initial fat grafting surgery.
Many patients referred to me for treatment of these frustrating and difficult post-blepharoplasty problems have reported more than just a cosmetic improvement. Excessive removal of skin and fat during upper and lower blepharoplasty can impair normal lid function and cause or aggravate dry eye syndrome. In some cases the fat grafting procedure will restore suppleness and flexibility to peri-orbital soft tissues, make eyelid closing easier, and improve the truly irritating and aggravating symptoms of dry eye syndrome.

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Blepharoplasty revision.

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Before doing any surgery, have an experienced surgeon fill the hollow with saline to see if you like it. It swill go away in a few hours. If you like that you can use Juviderm which is reversible and has the least downside!

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Be careful looking for help for this.

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Fat pearls are completely impractical as a solution for this problem.  The reason is that they create new scar tissue where they are placed and are completely unpredictable in how they survive.  This is a formula for needing more surgery in the upper eyelids.  Fillers can help to a degree.  While the service does not last forever, it may work for more than a year and, in some cases, for two years.  However, the treatment is an advanced method so you will not find someone offering this service in Illinois.  I also thing you should consider a detailed oculoplastic consultation with an experienced surgeon to assess your precise concerns and examine what is precisely going on.  This might lead to a plan to address your actual concerns in a manner that is different than your current thinking.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Sleepy Hollow: The Story of Set Upper Eyelids

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Deep set hollow of the upper eyelids are best treated with fat injections to provide correction.  The reason why the hollows are present is usually due to aggressive fat removal.  " REPLACE LIKE WITH LIKE".  Fillers can be used but my preference would be to start with fat.

Good Luck

Fat pearls vs fat grafting vs fillers

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Please be careful when a surgeon says:  "this is the ONLY way to do this". It shows a certain arrogance and stubborness that are not ideal qualities in surgeon, or anybody for that matter.

There are many different ways to "skin a cat". It depends on the surgeons training and experience. If one surgeon has not had success with a specific technique, it is not necessarily the techniques fault, it could also be "operator error".

Having said that, any surgical technique has its pros and cons, and you surgeon needs to be open with you in regards to this.

Fat grafting, fat pearls and fillers have all been shown to be effective in the proper setting and with good technique.

The pros of fat grafting via injection is its long lasting effect [if the fat survives] and the small incision [stab] requirement. Downside is possible lumpiness which may need to be addressed surgically. Furthermore it can be safely injected to the brow and sub-brow region, but not directly to the eyelids/orbits where the fat loss may have occurred.

Pros of fat pearls is that it is placed exactly where you are deficient in the fat [eyelid and orbit]. The downside is that an incision is required, and fat survival is variable and more than 1 surgery may be required. Some surgeons have shown excellent results, though results may not be the same in every patient, for example, patients that have had prior surgery do not do as well.

Fillers are excellent in that they are less likely to cause lumpiness and they can be revised. The downside is that they are not permanent.

Good luck.

seattleface com

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

Brow/eyelid volume augmentation

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Your options include fat transfer and other injectable filler (Juvederm, Restyalne) injection.  One is a surgery and permanent, the other is temporary.  Fat pearls can be used but fat transfer can do the same thing with minimal invasive approach.


Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

Hollow eyes post op

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without an exam, i would consider restylane to fill the infrabrow area safe, effecive, and reversible. 

Rafael C. Cabrera, MD
Boca Raton Plastic Surgeon

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.