Are dermal fillers a reasonable solution to correct upper eyelid hollowing? (Photo)

Question

I’m 34 years old and have noticed the inner half of my upper eyelids looking hollower than the outer half. It’s giving a tired or sad expression to my face. I can’t tell if the main issue is that the outer half is drooping, or if the inner half is hollowing, but probably a combination of both. Would dermal fillers be a reasonable and relatively long lasting nonsurgical solution in this area, which is starting to look like a rounder version of an A-frame deformity?

George Yang, MD · Answer

Hi aesthetica2345,
The inner half is hollowing as opposed to the outer half drooping or hooding. The best way to figure this out is to look at younger photos to see how your upper eyelid and brow skin looked when it was ideal. Is it possible that you have developed the hollowness from using eye lash or brow enhancing serums which make them longer and fuller? If so, the first recommendation is to stop them to see if the fat naturally recovers without any upper eyelid brow fillers. This phenomenon is called “Prostaglandin Associated Periorbitopathy”. The fat atrophies all around the eyeball, causing the fat to shrink under the eyeball (lower eyelid fat), behind the eyeball and the upper eyelid/ brow fat pads. 
If this is not the case, could it be from weight loss (illness, Ozempic, or stress from work or home)?
If none of these reversible causes are the case, then hyaluronic acid gel implant works well for this area and last years before wanting/needing a touch up. I have been using Restylane-L gel for upper eyelid hollowing since 2007 and for lower eyelids since 2005. The Restylane lasts years and may be considered a permanent implant when used around the eyes. Juvederm does not work well in this area in my experience. The Restylane is dissolvable with an antidote to wash it away if it is not serving to help our appearance. 
The Restylane will not stop aging, so the shape that we like and want will not last forever, however the Restylane implant is likely still mostly (60-90%) there even 5-10 years later. 
The nice thing that I like about using Restylane for this area is that it lasts so long and more can be added as they age or lose weight. If they gain weight, then the Restylane implant can be reduced or removed without surgery (Belotero Balance only seems to last about 6 months +/- so I don’t like to use it because it doesn’t last long enough.) Some injectors seem to be using Belotero exclusively even though their patients are flying from far away to see them. 
Although I began upper eyelid filling since 2007, I didn’t completely stop fat grafting this area until about 2010. My main gripe with the fat grafting is that when the patient gains weight the fat from their belly or hips which were grafted/injected around their eyes “grow” as if the fat were still on the hips or belly. The combination of the belly/hip fat plus the existing fat around the eyes becomes too much and it can’t be dissolved. If the patient loses weight the same fat shrinks with their weight loss. The filler can be added or subtracted without surgery and the new and old Restylane works well together. 
Best,Dr. Yang

Nuket Eroglu, MD · Answer

Hello; eyelids, over time, due to fat loss in deep tissues and loss of elasticity in the skin; folds and the eyes look even more sunken in. In this case, the application; should be done is; first of all, it is for increasing the skin elasticity. Thermage FLX and Ulthera; since they will create for youthfulness and tension in the skin; around eyes; these are the two preferred implementations. If the under-eye hole is very deep; if needed, dermal fillers can also be used as an addition.

Leonard Grossman, MD · Answer

Even though dermal fillers can be used to treat a hollow upper eyelid, they require a great deal of expertise and very few people produce good results. I use general fillers to correct your situation, but I still prefer to use your own fat, which does not have the same complications as general fillers And it produces more natural results. I would consider use it fast in your case. I hope this helps a good luck from New York City Plastic Surgery.

Are dermal fillers a reasonable solution to correct upper eyelid hollowing? (Photo)

Answers (3)

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