Deep upper sulcas
Thanks for the question. Based on the photo you provided, your primary issue appears to be a deep upper eyelid sulcus. A traditional upper blepharoplasty with removal of skin and fat would likely make your appearance worse. If the fat is repositioned into this area and not cut out, that would provide the result you are looking for. Filler would be another great option, and because most products are temporary, might be a better way to see if the surgery would provide a significant benefit. Good luck!
Surgical vs Non surgical Eyelid rejuvenation
Eyelid surgery, known as blepharoplasty, is designed to restore natural function and appearance to the eyelids. Eyelids are extremely delicate stuctures that are affected by many factors including genetics. Proper evaluation of the eyelids requires complete assessment of the anatomy and related structures. Thickness, pliability and quality of skin, degree of skin excess (known as dermachalasis), eyelid positions relative to the globe of the eye, integrity of the supporting ligaments, tendons and cartilage, excursion of the levator muscle (the fan shaped muscle that lifts the upper eyelid), symmetry of eyelid structures, amount and position of psuedoherniated fat (bulging of fat pockets that cushion the eyes in the orbit (eyelid socket), position and animation of the eyebrows and surrounding muscle (orbicularis oculi muscle), volume deficiencies of the soft tissues around the eyelids (dark circles known as Tear Trough depressions), are just a few of the structures and physiology that must be quantified prior to blepharoplasty or periorbital volume enhancement.
I would recommend personal evaluation by a Board Certified Oculoplastic Surgeon (Plastic Surgeon or Ophthomlogist) to ensure you develop the best treatment plan to address your concerns.
You have a deep sulcus, worse on the left. This occurs when a person doesn't have much fat in the upper lids. You can add some filler to the area, which will help to soften the appearance. Surgery does little to help this. If we try to just move down the crease, it will gradually move back up since there is no fat. If you have a large medial fat pad, this can be moved over into the central area, which can help with the hollowing. But I would try some HA filler first.
Sulcus under the eyes
I think based on your photo's that a filler or fat injections would be the way to go.you could do your lower lids and put some fat grafts in there but that requires surgery.
Upper Eyelid Hollow Appearance
It appears that you have a deep superior sulcus in both eyes, which is hollowing in the upper eyelid area due to the absence of fat. This can occur as part of the aging process, although some people are genetically more predisposed to showing evidence of this due to the shape of their faces and their eye sockets. This hollow area in the upper eyelids creates a shadowing effect that can give the eyes a more aged appearance. Along with the loss of volume in this area, the upper eyelid fold tends to move up higher or even disappear. In my opinion, the best option for rejuvenating this area would be to inject facial filler. Restylane is my preference for this area because it tends to hold its place better and does not spread out as much as some of the other products such as Juvederm and Belotero. I would be very cautious about having fat grafting done in this area due to the risks of asymmetry and scarring in the very thin skin of the eyelids. Surgery is probably not the best option for you at this time due to the risk of additional hollowing. Make certain that you consult with an experienced injector who is very comfortable treating this specific area of the face. Best, Dr. Gregory Lewen
It appears you have a deep sulcas due to atrophied or absent upper eyelid fat. This could be genetic or some cases due to prior surgery if the surgeon removed too much fat.
This area is very difficult to fix as fat grafting to the area has unpredictable results and injectable fillers are only temporary. Best way to figure the best course of action is to have a thorough exam in the office.