Post Blepheroplasty A Frame Deformity Filler Recommendation? (Photos)

Question

I had a double bleph approximately four years ago. The surgeon overcorrected and I now have upper lid A frame hollowness. I received a recommendation to have HA fillers from a MSPAS, PA-C injector who works for a surgeon in Palo Alto. My question is, given the risks of filler in the upper lids, is it advisable to use a PA or should this procedure only be performed by an occuloplastic surgeon? After my first procedure, I'm gun shy about taking any chances of another adverse outcome. Thanks.

Anna Chacon, MD, FAAD · Answer

Upper lid A-frame deformity after upper blepharoplasty is typically due to excessive medial fat pad removal, resulting in superior sulcus hollowing. Hyaluronic acid (HA) filler can be an effective, nonsurgical option to restore volume and soften the contour irregularity. When performed conservatively, with appropriate plane selection and small aliquots, it can produce very natural results.

That said, the upper eyelid is a high-risk anatomic area. The vascular network is complex, and although rare, complications such as vascular occlusion or vision changes are serious. In addition, overfilling can worsen heaviness or create contour irregularities in thin eyelid skin.

The most important factor is not the letters after someone’s name, but their specific experience with periocular filler and management of complications. An experienced oculoplastic surgeon is certainly well trained in this anatomy and may be a reassuring choice, especially given your prior surgical experience. However, some PAs and nurse injectors who work closely under physician supervision and who specialize in periocular aesthetics can also achieve excellent outcomes.

If you proceed, I would suggest:
- Confirming how frequently they treat upper lid hollowing specifically
- Asking about their complication protocol (e.g., availability of hyaluronidase, vascular management training)
- Ensuring conservative dosing with a staged approach

Given your understandable hesitancy, seeking consultation with an oculoplastic surgeon for at least one opinion may provide additional peace of mind.

Post Blepheroplasty A Frame Deformity Filler Recommendation? (Photos)

Answers (1)

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