Eyelid Hollowness After Upper / Lower Blepharoplasty

After having an upper and lower blephoplasty I was left with complete hollowness and new eyelids which look very aging. This was NOT what I originally went in for. The only reason I went in was for my right eye having SLIGHTLY less eyelid showing compared to the left eye which was perfect. Now he made the left eye with more eyelid which I hate and the right eye. What can I do to get my old eyes back or is this not possible?

Doctor Answers 33

Fat Grafting to Correct Hollows of Upper or Lower Eyelids

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If you  feel that your appearance at the brow-upper lid junction, and your under eye area seems more hollow since having the surgery, this can definitely be improved - and often completely corrected - by means of structural fat grafting. 

I often perform fat grafting of the brow-upper lid junction for patients referred because of post-blepharoplasty and/or post-browlift hollowness.  It is as you might expect a bit more challenging than fat grafting of the unoperated brow-upper lid junction, as scar tissue must be overcome in order to expand the soft tissue volume.  In most cases it requires the use of 'V-dissector' probes or cannulas (which have a tiny, V-shaped knife blade) to divide bands of collagen that tend to tether the skin to surrounding structures.  The correction of post-surgical hollowness is also more likely to require a second and even a third fat grafting procedure to produce the desired amount of lasting soft tissue fullness, compared to the treatment of patients that have not previously has surgery in that area.  Fat grafting recoveries are fairly quick and easy compared to browlift/bleph recoveries, so don't let that issue discourage you.

The earliest I would consider fat grafting this area after browlift and upper blepharoplasty is six months postop.  The longer one waits, the more successful a fat grafting surgery is likely to be.  There is no real need to wait, on the other hand, any longer than 12 months, as the condition of the soft tissues at the surgical site should stabilize at 6-12 months.

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

Hollow eyelids and blepharoplasty

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Some of the natural consequences of aging are the loss of upper eyelid fat, bulging lower eyelid fat and and the overall loss of facial fat. It is evident that there is virtually no circumstance where eyelid fat should be removed as this causes premature aging and violates our Hippocratic oath to "do no harm". Once the eyelids are hollow, repair and replacement of the fat can be challenging but since fat is deficient the treatment will be fat replacement in the form of fat grafts.  Treating the manifestations of aging include repairing weakened septal tissue and addressing the laxity and loss of skin tone on the lower eyelid. Many of these aging issues are exacerbated by poorly performed primary blepharoplasty but are treatable as long as the problem is correctly identified.

Paul S. Howard, MD, FACS
Hoover Plastic Surgeon

Eyelid hollowness after blepharoplasty, Eyelid fat repositioning

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Unfortunately, a negative of a blepharoplasty is that hollowness may occur. I have changed in most of my cases now to minimally removing the eyelid fat and repositioning what is there to give a smoother,more even transition into the lower cheek and to prevent hollowness from occuring. If it has occured, I have placed fat back from other areas. 

Revisional eyelid surgery

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Traditional blepharoplasties involve removing skin and fat.

Recently, there has been a move to reposition fat rather than remove it.

Also, there is a trend to maintain eye shape by means of canthal or lower eyelid support rather than just removal of fat or a pinch of skin.

In the case of a prior upper blepharoplasty where excess hollowness has occurred, we have had some success with fat-fascial grafts placed underneath the orbital septum to restore volume.

For hollowness from prior lower blepharoplasty, very conservative grafts with cheek elevation (cheeklift) procedures often help.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 188 reviews

Over resection of fat during an upper and lower eyelid blepharoplasty causing hollowness

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It appears that you had a reduction blepharoplasty meaning that fat was removed and skin was removed but nothing was done to restore the youthful volume to the peri-orbital area.   A correction may include a re-elevation of the skin flap, a suspension of the orbicularis muscle, repositioning of any residual fat to fill in the hollowed out areas and elevation of the lateral malar fat pad to fill in the lateral hollow.  The upper eyelids can be more challenging but on many occasions I have been able to find some orbital fat to replace in the lid to restore fullness if not then free fat grafting may be useful.  

Eye hollows after an eyelid surgery

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the most common cause for the hollowness to appear after eye surgery is from the fat removal. Some deepening of the upper eyelid crease can occur from adherence of the skin to the tarsal plate of the lid, but that is not common. if the hollowness needs to be corrected it likely needs a filler. Some doctors will use the patient's own fat, but I prefer hyaluronic acid fillers as they are more predictable, I feel.

Eye hollow

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in my practice i am very conservative in fat removal during eyelid surgery for this reason..it is hard to determine the exact problem without and exam or pictures...however fillers usually help and may last for some time.....good luck

Michael K. Kim, MD
Fort Myers Plastic Surgeon

This can be improved with filler but is an off label use.

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This can be improved with filler but is an off label use.  Look for an oculofacial plastic surgeon who is an injectable specialist for this kind of treatment.

Eyes look older after blepharoplasty

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Loss of volume in the upper eyelid with aging is normal and requires specific treatment to make it better.  If you are not happy after your blepharoplasty and feel hollowed out, there are a number of options.  It may not be your doctors fault,  but the loss of fat volume in the eye with aging is normal.  After waiting at least 6 months post surgery, you may be a candidate for either hyaluronic acid filler injection or fat injection. I have done both and the results are very impressive.  The key is going to an expert with experience using these techniques to treat the post blepharoplasty patient, don't skimp on this important detail-find an expert!!

Julius W. Few, MD
Chicago Plastic Surgeon

Correcting eye hollowing after blepharoplasty

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Your expectations for your eye surgery were not met,  however you may achieve some improvement by judicious use of "off the shelf" fillers such as Resylane or micro fat grafting.  Both procedures should be done carefully by an experianced plastic surgeon.  These procedures likely will need to be done several time to get maximal benefit.

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.