Restylene for hollow upper eyelid?

When I was 4 I had retnoblastoma and had my right eye removed, and received an orbital implant/prosthetic eye. Since that time, my right eye has gradually begun to look more and more hollow. There is basically no fat in the upper eye lid, and this prevents it from looking naturally. I was wondering whether restylene injections would be an effective treatment? I know I should consult with an oculoplastic surgeon, but I am a student, and what to know what to expect before I save a bunch of money.

Doctor Answers 5

Restylane for behind the implant as a foundation before filling the upper eyelid hollow

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Hi Angel of avarice,

Great question.  Hollowing of the fat inside of the eye socket (orbital fat) is a special interest of mine.  I am a facial plastic surgeon, but I was inspired by Dr. Frank Meronk (retired) with his website and insight about eyelid hollowing.  He has some amazing before and after photos of his work for upper and lower eyelid hollowing.  I have adapted his technique by using Restylane after years of copying his technique of using pearl fat grafting to replace the volume.  I started using Restylane when I had some younger patients in 2008-9 with very slight upper eyelid hollowing, but did not want to perform an incision on them to replace the volume.  Since I knew the anatomy well from performing the pearl fat grafting, I was able to learn to inject the Restylane into the same pocket.  This is different from injecting Restylane into the brow fat pad, which is a different look (Val Lambros.)

This technique works best on younger patients, but for much older patients who also had upper and lower eyelid hollowing, I suspect that they have senile enophthalmos, which is loss of fat behind the eyeball.  

I read an article from 2007 by Raman Malhotra, Deep Orbital Sub-Q Restylane (Nonanimal Stabilized Hyaluronic Acid) for Orbital Volume Enhancement in Sighted and Anophthalmic Orbits. Arch Ophthalmol. 2007;125(12):1623-1629.  The injection of Restylane behind the eyeball or prosthesis had a similar effect of filling only the upper or lower eyelid hollow.  Why?  As the eyeball moves forward towards the tip of the nose, the volume of the eyeball is actually filling the hollow on the upper and lower eyelid. 

I do not offer the Restylane injection behind the eyeball procedure.  I have contacted Dr. Malhotra in the UK by email, and he says that he still does the procedure regularly on non-sighted eyes and occasionally for sighted eyes with good outcomes.   Now that the Restylane has the lidocaine mixed into it, he does not have to prenumb before performing the Restylane injection.  He can do it in one step.  Apparently, this injection is a standard injection for numbing the eye with local anesthetic for eye surgery.  Although I am comfortable with injections above the globe, the injection behind the globe should be performed by an occuloplastic surgeon.

As your bone structure has grown since your current orbital implant/prosthetic eye, your orbital volume has increased which leaves the remaining fat less supportive, and  thus the prosthetic has become sunken.  

Since I am not an occuloplastic surgeon, perhaps you can ask if insurance cover a "replacement" or update of your prosthesis?  Perhaps the prosthesis can be shaped in a way to include the volume that you need to fill the orbital volume and get the prosthetic to reach the same level of your sighted eye.  If this looks good, perhaps you would not have to get the annual or biannual Restylane injection indefinitely.  

I hope this helps. Good luck in your studies.  I am really happy to see an Rb patient all grown up.  I wish you the best and hopefully you can find a longer term solution with an occuloplastic surgeon.


Dr. Yang

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New York Facial Plastic Surgeon
4.8 out of 5 stars 33 reviews

Fat Grafting for Hollow Upper Eyelid

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I regularly perform structural fat grafting in the hollow above the eyelid. The result is very natural looking. Look at the before and after images on my website to see results.

I would avoid Restylane or any other injectable filler in this area. Grafted fat will be the safest and provide the most natural looking and most lasting result.

Select your plastic surgeon carefully as this procedure requires extreme expertise, precision and patience on the part of the surgeon.

Best of luck to you.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Restylane in eyelid hollow

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This is a tricky area and comes with certain risks and thus cannot advise treatment in this area. would suggest you discuss all risks with cosmetic surgeon first. 

Steven Hacker, MD
West Palm Beach Dermatologic Surgeon

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Filler to fill hollow socket (after eye removal)

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Fillers can definitely help fill the hollow in and around the right eye or eye socket.  They are safe, predictable and last a few years. You should see an oculoplastic specialist for it.  (As a side note, the right eye prosthesis seems a little big, likely made bigger trying to compensate for the hollow socket.)

Hollow upper lid

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Fillers like restylane are one option to restore fullness. However insurance may not cover it as you know. There may be more definitive surgical treatment with implants, Dermis fat graft or fat injection That will likely be considered reconstructive and covered under insurance As well as provide a long-lasting effect. I think you would benefit from undergoing a consultation with an oculoplastic surgeon to see what your options are. Best wishes.

Malena Amato, MD, FACS
Austin Oculoplastic Surgeon

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