Orbital Fat Loss - What Can Be Done? I'm 49, my Eyes Look Much Older. (photo)

Looking at your photos, it seems that your upper eyelids are somewhat droopy [eyelid ptosis]. Furthermore, I think that you are subconsciously elevating your eyebrows to compensate for this.

Raising your eyelids [ptosis repair] will definitely help your upper eyelids become less hollow. But you should be aware that your subconscious drive to raise your eyelids may go away and unmask a mild droopy eyebrow.

I would recommend consultation with an Oculoplastics surgeon [or a Facial Plastic surgeon or General Plastic surgeon that has extensive experience with eyelid ptosis repair].

You can find an ASOPRS trained Oculoplastics surgeon near you. The link is provided below.

I agree with trial of filler which is reversible and then if you like the effect .proceeding to fat grafting. However with micrcannulas and experience the results from fat grafting are very reliable and. Softer and more even than fillers in my hand. The key is to not over correct. Fillers or fat can always besupplemented

   I would agree there is some volume loss, but the eyelid ptosis is noticeable and should be corrected.  Kenneth Hughes, MD Los Angeles, CA

You have upper eyelid ptosis (droopy) which causes your eyebrow to be lifted in order to assist lifting the droopy upper eyelids. That causes the upper eyelid area to be stretched and unveil the hollowness that is present with aging. So, the main treatment would be upper eyelid ptosis surgery.  Filler or fat injection can be injected into the brow/upper eyelid area if necessary but that would definitely be secondary. See an oculoplastic surgeon.

Thank you for the question and for posting your pictures. This is a great strategy, and one that I often advocate with my patients. If you are not sure how you will like an augmentation procedure (e.g., fat grafting or placement of a facial implant), you can "try it out" by having some temporary fillers placed. For the tear trough region (hollow area under the lower eyelids), I use Restylane. For the cheek area or lateral brow/temple region, I use either Juvederm or Radiesse. These products will last anywhere from 6 months to a year, depending on the patient and where the product is placed. Best of luck going forward!

The pictures do show a orbital fat loss and  very hollow upper lids. From the pictures is also apparent that there some ptosis present.  Repairing the ptosis will reduce the aperture of the  eyelid opening and help from raising the eyebrows to compensate for the ptosis. Best to seek out an oculoplastic surgeon well versed in ptosis repair and a possible small amount of fat grafting to the upper lids. 

You do have hollowing around the eyes from loss of fat tissue support.  A fat transfer or filler (done with a very experienced injector who is comfortable working in this area) is a good solution.

Before you proceed get an evaluation for the droopy upper eyelids that come from weakening of the upper eyelid "lifting" muscle, (called "ptosis") to see if you need a tightening procedure.  That will also help make you look less hollow.

Good luck.  I think your objectives are possible.

Depending on what is truly bothering you the most, you have several options to rejuvenate your eyes.  It appears as if you may have ptosis of the upper eyelids which can be treated with a fairly simple procedure and would help "brighten" your eyes.  You also have hollowness under your lower eyelids which can be treated with in office injections with restylane or juvederm or autologous fat transfer.  These results can last anywhere from 6 months to several years depending on the modality chosen.

Great question and posted photos. Options are fillers like HA's or fat grafts. Best to obtain in person opinions. 

You do appear to have a deep or hollow upper eyelid sulcus. In your case, this results from drooping upper eyelids. Not extra skin, rather excess laxity in the eyelid elevating muscle. This condition is called upper eyelid ptosis and can be repaired. This should improve the appearance of your upper eyelids and should be performed before considering adding any fillers to this area. I hope this information is helpful.Stephen Weber MD, FACSWeber Facial Plastic Surgery