Hi Smokyeyes,Yes, upper eyelid filler can be done to add back volume to your brow fat pads. I have been performing upper eyelid fillers since 2007 and fat grafting to the same area prior to 2007. I stopped performing the fat grafting after 2010, when I felt the results of the upper eyelid filler was better than the fat grafting. It also turns out after 16 years of experience performing this procedure, that the hyaluronic acid filler implant lasts many years and does not go away after 1 year as reported by nearly all of the new upper eyelid filler providers. I have patients who are 9-10 years out without refilling, with the average around 3-6 years coming back for a partial touch up. If the upper eyelid filler only lasted 6-12 months, I would have likely continued with the fat grafting. The upper eyelid is actually the skin between the upper eyelashes and the upper eyelid fold. The skin above the upper eyelid fold is really brow skin and not really upper eyelid skin. Upper eyelid surgery trims back the brow skin to reveal the upper eyelid (AKA upper eyelid platform). Although you already had upper eyelid skin removal, you still have the “appearance” of loose skin above your upper eyelid platform. The best way to figure out what to do next is to review your younger photos to see if your younger eyes were more hooded (Brow skin to upper eyelid platform ratio of 55-85% to 45%-15%) meaning you had more brow skin fullness and brightness above the eyelid than the amount of eyelid actually showing. If so, upper eyelid filler implants (brow fat pad implants) will help to restore that appearance. When reviewing the younger photos, you should also note whether or not your eyebrows were actually higher or possibly naturally lower. If so, then my philosophy is to try to make the patient look more like their younger selves, then I would not recommend a browlift without seeing someone’s younger photos, otherwise that would be a cookie cutter approach. If in fact your eyebrows were higher, then an eyebrow lift would make sense. After analyzing thousands of older people, compared to their younger photos/appearance, I have come to the conclusion that when people are younger, there is no evidence is the bony edges of the eye socket, both when the eyes are open and even more so, when the eyes are closed. The upper eyelid/brow filler implants help to camouflage the eye socket/skull edges as well as the visibility of the eyeball within the eyesocket. Take a photo of yourself with your eyes closed and then look for images of young people with their eyes closed or looking downwards. These can be found in clothing catalogues or pictures of models in fashion magazines. You can see the eyeballs with the socket more in the older models/people versus the younger models. By really observing the true aging process, can we make better decisions on how to reverse it and still look like our younger selves. The state of current surgical techniques seem to make people look less haggard and less tired looking, but not necessarily (sometimes it happens) making them look anything like their younger selves. Starting from the beginning (younger appearance) can we better find our way back there. Best, Dr. Yang
