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

I really didn't know what 'Topic' to put this under. I don't want surgery - thinking more along the lines of fillers for the upper lids/brow-bone and lower lids. I've read it can achieve a fuller lid and can be reversed if, I don't like it. I realize it's a temporary fix, but it will buy me some time before committing to a fat transfer procedure. Seeing my pictures, do you think it's possible to obtain a more refreshed, less sad look, with this type of treatment? Thank you in advance.

Doctor Answers 16

Eyelid ptosis

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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.

Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

Eyelid Injections Instead of Surgery?

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You are correct that we can very often temporize surgical rejuvenation with volumizing injections in the eyelid area. But from the pictures provided, it would seem you could have a medical condition that might require addressing first. Ptosis is a condition in which your eyelids can't be raised fully- when your upper eyelids are in a perpetual state of "half mast". My advice?  Get yourself examined before anyone puts any fillers or fat into or around your eyelids.  I think you'll find that ptosis repair might solve much of your distress over the appearance of your eyes. Thanks for the question!  -Dr. Capone   

Randolph Capone, MD, FACS
Baltimore Facial Plastic Surgeon
4.7 out of 5 stars 51 reviews

Eyelid ptosis?

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It looks like from your photos that you have eyelid ptosis.This may make the eyes appear more hollow.  Correct that first, and then see if you need fillers, etc.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Upper eyelid ptosis with older appearance

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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.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

Ptosis and hollow upper lids

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Melody I would have to see you in person,but I think a good first step in improving your eyes would be doing a conservative upperlid bleph. with levator elevation. Any tissue harvested during the bleph. could possibly be used to make the upper lid concavity less severe. This is not saying that you still might need a filler in the upper lids.If you have fat injected in your upper lids I would suggest you see someone like Sydney Coleman M.D. the professor of fat injections.

Terry A. Cromwell, MD (retired)
Lafayette Plastic Surgeon

Orbital fat loss

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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. 

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Fat depletion from eyelid areas

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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.

Deborah Ekstrom, MD
Worcester Plastic Surgeon
4.7 out of 5 stars 39 reviews

Combination of upper eyelid ptosis and hollowness of lower eyelids

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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.

Neena Will, MD
Chicago Facial Plastic Surgeon
4.9 out of 5 stars 18 reviews

Address eyelid ptosis first

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Before considering fillers, please be seen by an oculoplastic surgeon (an ophthalmologist who does eyelid surgery) and have an evaluation for eyelid ptosis.  That may be more of what you have than fat loss.  Also, when considering fillers, you can always have a saline injection to see if you like the effect.  This will go away in a few hours but the amounts and technique can be determined for you if you happen to like it and want to convert to HA's.

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

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

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.