How Safe Are Fillers Like Restylane for Upper Eyelid Area?

Upper eyelid hollowness is a dramatically underappreciated, yet incredibly important component of aging in the eyelids. With normal aging, our upper eyelid fat pads tend to retract and expose this upper lid hollowness, those with “deep set eyes“ are especially prone, and unfortunately old-school upper eyelid surgery that is overly subtractive can artificially create this hollowness early, actually looking worse than it did before surgery - the before and after photo in the link below resulted from overly subtractive upper eyelid surgery with another surgeon, and you can see the results after revolumization of the upper lids. Correcting this hollowness can happen with fat or filler injections into very specific planes of the upper eyelid, or transposing and rearranging the upper eyelid fat pads to provide fullness, as you see in this surgeon’s view video, borrowing the excess fat to move into the areas lacking fullness!
To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these “core four” cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.
Cameron Chesnut
#realself100 Physician

There is always a risk when injecting any product, however, certain areas of the face are at higher risk than others. I'm unsure of statistics to date, however visiting the website of the particular filler you're considering is a good place to start. In reality, the incidence of blindness and/or serious side effects are very low, but there are no guarantees either way.

It is critical that the injector have an intimate and detailed surgical knowledge of the anatomy being treated.  By respecting the anatomy of the area being treated, complications are avoided.  WIthout this detailed knowledge the risk is that the injector will inject filler intravascularly which can have an adverse effect on the circulation.  While these treatments are amazingly safe in the right hands, I am not aware of any injector, ASOPRS or not, who guarantees the safety of these treatments.  Do not have these services if you are not 100% comfortable.

Hyaluronic gel fillers can safely be injected into lower or upper eyelid and brow hollows.  The risk of vascular occlusion is extremely low, and in fact, lower than injections in the nasolabial folds.  See following link/manuscript and video. 

Fat grafting to the upper eyelids can provide a beautiful, natural and permanent result. It is the only material I would consider using in the upper eyelid area. Vuew many photos and carefully check the credentials of plastic surgeon to be certain you are in good hands. 

At this point, it is impossible to say 'how safe' fillers in the upper eyelid area are. The consensus from my personal Oculo-Plastic, dermatologist and Plastic Surgeon colleagues is this: Don't use Juvederm or Radiesse by the eye. Juvederm is well known to be more likely to cause inflammation or swelling ... and Radiesse cannot be dissolved if there is a problem. Restylane or Belotero are the safest optionsMake sure the injector is experienced and prepared to dissolve fillers if there is a problem. Anyone who is getting filler should feel comfortable to ask, "Do you have Hyelenex or Vitrase available in the office?" Not all doctors stock it, because it is expensive and goes bad if it doesn't get used (which, hopefully is the case). Sometimes it takes a day or two to get it from a local pharmacy. If your doctor has it available, you can feel comfortable that they've used it before, know what to do and are prepared. Yes, the risk is blindness. This is a rare complication, but how rare is hard to tell. Blindness is a risk for any procedure around the eye, including fat transfer. Good Luck and make sure to work with an experienced Oculo-Plastic Surgeon!

The only places I regularly use fillers near the eye are


in the tear trough/dark under eye circles

to accentuate the soft tissue and bony prominence immediately below the tail of the eyebrow to give the eyebrow volume and lift. 


The only fillers I use around the eye are hyaluronic acid fillers.  The main purpose of hyaluronic acid in the skin is to hold onto water molecules.  That is what gives volume and firmness to the skin.  The more delicate the skin, the greater the risk that swelling will stay for a long time.  So injecting fillers into the upper eyelid, besides the danger of injecting into a blood vessel, can also result in a swollen, heavy eyelid for a long period of time.

In our practice, we do not treat the upper eyelids. The tear trough area (lower eyelid)  is one that is often treated using Restylane or the newer Belotero with purported less risks of Tyndall effect.

Fillers are not commonly used for the upper eyelids, but are used more commonly in the lower eyelid tear trough region.    There are known cases of blindness with injection into a vessel but it is extremely rare.

Injections done by any less than experienced injector can lead to problems; however, the eye area is extremely difficult. The skin is thinner and delicate, the swelling needs to be managed and will be more excessive, and there are all sorts of vascular problems that can occur if it's not done by someone with extreme experience in this type of injection. I would consult with your physician on any other possible treatments to resolve your overcorrected upper eyelid surgery. While HA fillers can be dissolved and will have less of a problem than fat transfer, there are still a number of factors to consider and a number of risks.