Can I repair hollowness above orbital rim? (photos)

Question

A bad lower bleph left me hollow above and below the orbital rim & with scleral show. I have since had two fat grafting procedures and a canthopexy which have fixed everything but the hollowness above the orbital rim. While improved, this area is still not what I want. What are my options? It seems like it would be very difficult to get fat into this area, and probably even harder to get the contour right. If it can be improved I definitely want to, but if not then I should let it go.

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question. You probably would benefit with injection of fillers in the depressed area. See a specialist in this region of the face. Good luck,

Jessica Lattman, MD · Answer

I would suggest Restylane injection to the hollow area.  Unlike fat, restylane can be molded to fill in the affected area.  In my experience you would be a good candidate for this.

Stephen T. Greenberg, MD, FACS · Answer

Thank you for your question.Based upon the surgical history you describe and the photos that you included with your post, I believe that you might benefit from Restylane injections to the tear trough.  Restylane is a hyaluronic acid (HA) filler that can safely be injected into this region for a natural 'plumping' of this very common hollowness.  Additional fat grafting could potentially be an option, but I believe that Restylane would be a good next step.  A physical exam would be instrumental in providing you with the best recommendation and I would encourage you to seek out a consultation with a board certified plastic surgeon who is well-experienced in facial procedures.  At the time of your consultation, and based upon your physical exam, all of the options available to you can be thoroughly reviewed.  I hope you find this helpful.

Benjamin Caughlin, MD, FACS · Answer

We can definitely get fat into the superior orbital rim. I often use this to lift the brow slightly in patients.

You have experience with fat grafting so you know the downtime and procedure but it is a great option for something like this. There will be some swelling. The upper lids swell more than the lower lids so it can take up to a week to recover.

Fillers are your second option. I like them less for this area. You need a decent amount of volume here it appears from your photos so that will add up to likely almost what fat cost.  Plus they are shorter lasting when compared to fat.

Hope this helps.

Best of luck,

DrC

John J. Martin, Jr., MD · Answer

You do look pretty good now.  And I agree that fat would not be a great choice for filling that area.  You could try some HA filler such as Restylane or Belotero.  Make sure you go to someone who does a lot of lower lid fillers.  If for some reason you don't like it can always have it dissolved.

Can I repair hollowness above orbital rim? (photos)

Answers (6)