How Can I Improve Upper Eyelid Hollowness? (photo)

Leave you lids alone--they look normal and do not need anything. You can always find a surgeon to tell you what you want to hear!

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

Eyelids are delicate structures with the thinnest skin in the body.  In order to avoid problems (lumps, etc), it is best to use absorbable fillers that are also reversible. The best is Restylane. I have a written an article on this topic, which you can find on my website.  Consult an oculoplastic surgeon to determine if you are a good candidate for it.

I read your concerns and reviewed your photos:

You could have the hollow you're pointing to filled, but I'm not sure this would make you look better or make you happy. That hollow area is a typical location of the upper eyelid medial fat-pad, and adding volume to this area may not look attractive.

You can see this hollow because your upper eyelids hang a bit low (ptosis), with your left eyelid hanging lower than your right. If you're concerned about the appearance of your eyelids, consult a reputable, certified oculoplastic surgeon to see what might be best for you.

I hope this helps you.

Dr. Joseph

I've filled this area with Juvederm and Restylane in the past, and Dr. Val Lambros published a paper about it some time ago.  Obviously, the operator is an important part of your outcome.  You need somebody skilled, and the injections should be done very slowly and incrementally.  You look in the mirror after each small aliquot is placed to see the result as it develops, and let the operator know if you want more, and where.

 

You are the kind of patient who would benefit only from a very, very conservative fat grafting to the inner upper eyelid. By searching the fat grafting before and after section on Realself, and on the websites of plastic surgeon with expertise in fat grafting, you can take a look at many patients who have had very minor fat added that has resulted in a more youthful and vibrant appearance.  Be certain you do not find a surgeon who believes in overfilling the eyes, or any area of the face with fat. 

Deficient periorbital volume due to aging or secondary to surgery can be restored with either hyaluronic acids (Restylane, Juvederm) or fat grafting.  

Although filler might be an option, if carefully injected in small increments, my gut reaction is to point out that everyone's facial architecture is different and not to encourage you to rush to get those upper eyelid hollows treated.  I also note that you ahve some early aging in the glabellar area and low brows.  One possibility is to see a plastic surgeon in consultation to determine whether the problem is, in fact, brows that might warrant elevation at some point in the future which have created the impression of upper eyelid hollows or to consider botox to the glabellar area for brow elevation.  This can't be assessed just by a photograph and may be a reasonable query to pose to a plastic surgeon. 

Hello, Daniel

You've got 3 to 4 options with some pros and cons:

1.  Filler (Restylane or Juvederm):  PROS; safe, affordable ($550), if you don't like it you can melt these "HA" fillers with an enzyme.  It's great way to see how you would look with more permanent solutions.  Should last about 9 to 12 months.  CONS;  temporary, potential bruising, need to have it injected by a facial plastic or oculoplastic surgeon.

2.  Fat transfer:  PROS; safe, quick, affordable ($1000+), if fat takes well could last up to 7 years.  CONS; could be uneven, needs to placed by experience facial plastic or eyelid surgeon (special training/experience), potential bruising

3.  PRP (platelet rich plasma from your own blood):  PROS; easy, safe, affordable ($800+), subtle, no risk of reaction since it's your own blood.  CONS; longevity uncertain (3+ years), potential bruising

4.  Surgical placement of tissue (fascia from behind ear):  PROS; permanent, costs about $2,000, reliable.  CONS:  small chance it's uneven, small surgical incison (but hidden in eyelid crease), needs special training/experience from a facial plastic or oculoplastic surgeon

Hope that helps,

Chase Lay, MD