Injectable Fillers for Hollow Upper Eyelids?

Regardless of what is injected, the upper eyelid needs to be approached with caution. The anatomy is very delicate and unforgiving, so make sure to go with someone with a lot of experience with injections in this area.
That being said, fat or Restylane can work very well, and there are pluses and minuses to each option.
Meet with an experienced surgeon in your area, or perhaps more than just one, listen to his or her thoughts, and pick the individual you feel the most comfortable with.

I often find patient in my office who are dissatisfied with the results of blepharoplasty performed elsewhere because it left them with a sunken upper eyelid appearance (upper eyelid sulcus).  In some cases, they are just not pleased with too dramatic of a difference in upper eyelid platform showing after their surgery.  Injectable fillers can be successfully used to fill these hollows, but only when done by a specialist that is keenly familiar with cosmetic eyelid surgery and has considerable experience with this procedure.  Restylane, juvederm, or belotero are all reasonable filler options, and in some cases fat grafting is also an option.  See my link below for a more detailed explanation of how hollow upper eyelids can be corrected.

Upper eyelid hollowness is a dramatically underappreciated, yet incredibly important component of aging in the eyelids. With normal aging, our upper eyelid fat pads tend to retract and expose this upper lid hollowness, those with “deep set eyes“ are especially prone, and unfortunately old-school upper eyelid surgery that is overly subtractive can artificially create this hollowness early, actually looking worse than it did before surgery - the before and after photo in the link below resulted from overly subtractive upper eyelid surgery with another surgeon, and you can see the results after revolumization of the upper lids. Correcting this hollowness can happen with fat or filler injections into very specific planes of the upper eyelid, or transposing and rearranging the upper eyelid fat pads to provide fullness, as you see in this surgeon’s view video, borrowing the excess fat to move into the areas lacking fullness!
To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these “core four” cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.
Cameron Chesnut
#realself100 Physician

Upper eyelid filler injection is very safe, predictable, and effective, when done properly by an experienced physician. The result lasts normally 1-2 years the first time it is injected and even longer the second time. See following link/manuscript.

Hi Sashaei,

Good question.  Yes, injectable fillers can be used to fill upper eyelid hollows.  This is an "off-label" use for fillers such as Juvederm or Restylane.  I prefer Restylane over Juvederm, mainly because Juvederm can increase in size by ~10% after the injection.  If you do a web search for "Juvederm overfill under eyes," you will find many stories of people who looked good right after the injection, but later the result is too puffy.  

 

Although hollowing of the eyelid area is not desireable, having too much puffiness or "bags" is worse than hollowing.  The goal is to fill the area until it looks smooth and flat, but not puffy.  It is important to go on the provider's website to see their before and after results, to see if the provider really has experience injecting upper eyelid fillers. 

 

I started treating upper eyelid hollowing initially with fat grafting in 2006.  I mainly performed a procedure called "Pearl Fat Grafting" of the upper eyelid hollowing, and still do.  However, for younger patients like yourself, who do not need any skin removal, I prefer to inject Restylane as an upper eyelid filler to volumize the "brow skin" or the skin between the eyebrow and the upper eyelid fold/crease.  

 

One key photo to determine if your injector is truly skilled at upper eyelid filling is the photo when the patient looks downwards.  If performed properly, it should look very smooth.  If injected in the wrong area, it can look lumpy.

 

I hope this helps to answer your question.  Good Luck!

 

Best,

Dr. Yang

 

The upper eyelid area can be corrected with fillers such as Juvederm or fat but it must be done in small increments with small needles and with precise technique.  Usually the medial portion requires more filler than the lateral or middle portion.

 

This is a major problem after upper blepharoplasty. Juvederm is an excellent choice for filling in this deformity. It is best to seek a board certified plastic surgeon who is comfortable with these injections. I recommend starting with small amounts of juvederm injected over multiple sessions. Micro fat grafting is also a great choice, however, over-injection errors with fat are not so easy to reverse.

As we age, we lose volume in our face. This includes the upper eyelids, eyebrows, and orbit. Changes that make us look aged include not just skin drooping, but loss of volume in these areas, and hollowness around the eyes.
Blepharoplasty surgery is designed to reduce fat in the orbit and tighten the skin of the eyelids. If you had a blepharoplasty that removed a lot of orbital fat, then it may make you appear very hollow. This may make you look a lot older than you really are.
You are right to ask about volume enhancement with Juvederm to reverse some of these changes. Juvederm is an excellent choice for your problem. The filler can be used to add volume to your orbit, eyelids, and brow to produce aesthetically pleasing contours. Another option (perhaps more permanent) would be fat transfer to your brow and orbit areas.
Good luck!

Whether we use fillers or your own fat, this area is extremely sensitive to any type of augmentation. It should be done only by someone with a great deal of experience and usually with Juviderm is done with 2 or more injections, so as not to create a lump.

Many very attractive people (celebrities included) with hollow upper eyelids could look much younger and attractive with natural-looking fullness in their upper eyelids. The correction of hollow eyelids, when performed expertly by a plastic surgeon with considerable experience and expertise in structural fat grafting can provide a beautiful and natural looking result.

My approach to upper eyelid surgery is to be conservative with skin excision, and to reserve excision of fat for patients with significant fat excess. In my opinion, aggressive removal of upper eyelid skin and fat is a 'skeletonizing' procedure which risks making eyes appear more deep-set and aged, rather than younger. In fact, in many patients I perform structural fat grafting (using the patient's own fat, from the abdomen or hips) to help restore soft tissue volume around the eyes.

The next time you flip through Vogue or Allure (guys, just grab one at the checkout stand) take a close look at the eyes of the models. In most of them, women in their teens and twenties, you will see only a sliver of the upper eyelid, if it is visible at all. In many, the upper lid is completely obscured by soft tissue fullness between the brow and eyelashes, which I sometimes refer to as the 'brow roll'. Perusing the fashion magazines provides quick confirmation that the youthful upper lid is not a skeletonized upper lid.

Following fat grafting to the upper eyelids most patients report that people tell them “you look great” but they cannot detect what has changed.