Surgery for Upper Eyelid Hollows? (photo)

Years ago, I had upper eyelid surgery. As I've aged the hollows in the upper eyelids have worsened. I've been told that there is a surgical procedure that removes a bit of muscle from the temporal fascia and placed in the hollows. Have any of your doctors done this procedure and is it effective in restoring the upper eyelid hollows. Thank you, Valborg

Doctor Answers 14

Upper Eyelid Hollows

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Many of my brow-upper lid junction structural fat grafting patients have come to my practice for the correction of hollowness created by the over-zealous removal of fat during an upper blepharoplasty surgery. I am continually amazed at how many cosmetic surgeons practice 1970's-era blepharoplasty surgery in the 21st century. I almost never remove upper lid fat during blepharoplasty surgery, and in many cases I actually add fat at the brow-upper lid junction. Fortunately, essentially all cases of post-blepharoplasty hollowness can be improved dramatically by structural fat grafting. It is a more challenging procedure, as scar tissue must be overcome to create space for the grafted fat, and in many cases it takes more than one fat grafting procedure to restore adequate fullness in these patients.
Lower lid hollowness following an overly aggressive lower blepharoplasty can likewise be improved. One must exercise care and caution, as lower lid skin and the underlying soft tissues are usually quite thin, and thus the lower lids are less able to conceal grafted fat. Fat grafting must be preformed conservatively here, with a plan for secondary and occasionally tertiary fat grafting procedures depending on the 'take' of the initial fat grafting surgery.
Many patients referred to me for treatment of these frustrating and difficult post-blepharoplasty problems have reported more than just a cosmetic improvement. Excessive removal of skin and fat during upper and lower blepharoplasty can impair normal lid function and cause or aggravate dry eye syndrome. In some cases the fat grafting procedure will restore suppleness and flexibility to peri-orbital soft tissues, make eyelid closing easier, and improve the truly irritating and aggravating symptoms of dry eye syndrome.

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Fat Grafting below the Brow

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   Fat Grafting below the Brow will give the appearance of fullness at that interface.  Ptosis repair can be performed as well.

Upper eyelid hollows

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 I do not do this proceedure and I would proceede with caution as the chance of a bad result seems very likely to me.

Improving upper eyelid hollows

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Thanks for the photos. You have eyelid ptosis, very hollow upper eyelid sulcus, high upper lid crease fold and periorbital hollowing. You most likely have significant amount of skin and fat removal from prior upper blepharoplasty. There are different ways to improve your periorbital appearance, ranging from fillers which provides limited, and incomplete improvement, all the way to redo upper blepharoplasty with ptosis repair and fat grafting. Make sure you understand the pros and cons of these treatment options and consult several well-qualified surgeons before deciding what to do. Your own level of risk tolerance will also influence which treatment option that you choose.

Best Wishes,

Stewart Wang, MD, FACS
Los Angeles Plastic Surgeon
4.6 out of 5 stars 28 reviews

Upper Eyelid Hollows

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Two factors contribute to hollow upper eyelids. One is upper eyelid ptosis (droopiness) and lifting the eyelid (ptosis surgery) can help fill the hollows to some extent.  The other factor is age-related fat loss from the face and eyes.  That can be improved by injecting fat or fillers around the eyes.  See an oculoplastic surgeon for evaluation.

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


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I have not done this procedure.  However, I think you might also want to consider autologous fat transfer by someone who does a lot of it.  If you contact us, I can recommend some excellent physicians in the New York-New Jersey metropolitan area who are real experts in this.

Stuart H. Bentkover, MD
Boston Facial Plastic Surgeon

Hollow upper eyelids

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Thanks for providing us with pictures.

As mentioned by others , you have a complex problem and to figure out the best remedy you need a careful examination by a Plastic Surgeon well versed in eyelid surgery. To see how you open & close your lids and how they appear when doing so photos alone cannot show.

It appears that you have some eyelid ptosis ("lazy upper lids"), hollowness of the upper lids with "high"scars/incisions from previous eyelid surgery.

Depending on the findings during the examination the spectrum of options to treat your problem(s) is from no surgery at all to several procedures in one or different settings.


Good luck !

Guido P. Gutter, MD
Evansville Plastic Surgeon
4.9 out of 5 stars 18 reviews

Surgery for Upper Eyelid Hollows?

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Carefully injected fillers or fat grafts can help. But you need a true expert in injecting upper lids. 

Revision upper eyelid surgery

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Looking at your pictures, there are two separate issues that should be evaluated further with your upper eyelids.  The hollowness that you mentioned could be improved by several different procedures. Commonly, this is improved with fat grafting or transfer to restore your lost volume.  This would improve the contour and shadowing that you have and give a smoother shape to your lid crease.  Fat transfer involves harvesting your own fat from one part of your body such as the abdomen or thigh area to inject around your upper eyelids.  From your pictures, you also look to have lowering of your eyelids, which needs to be evaluated in person with a thorough physical exam.  You may also benefit from a ptosis repair to improve your eyelid position on your eye.    

Jessica Kulak, MD
Fairfax Facial Plastic Surgeon
4.6 out of 5 stars 27 reviews

Fat grafting to improve lids

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Dear Valborg, Your problem is often seen in a blepharoplasty done years ago.  At that time we removed much more fat thyan we do now.  One treatment I would suggest is to have fat grafting performed which will help greatly to soften the upper lid.  Speak to someone who has done this before and don't rush into the first doctor who only wants to put restylane or any of the hyaluronic acids.  Although this is an option I feel your own fat whould be the best to use.

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