Correcting upper blepheroplasty - hollow and asymmetrical result. (Photo)

I had upper blepheroplasty 3 years ago and have been left with very hollow eyes, one considerably worse than the other. It also completely changed my eye shape which used to be almond. I've had a number of consults - one suggested a procedure to move where the crease is, another suggested filler, another suggested fat grafting. Is there a reliable and safe way to correct this?

Doctor Answers 4

Correcting Hollow upper lids

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  • Experiencing unexpected changes of the eyelid appearance as a result of surgery is not good and is most upsetting for a person.
  • You did not show photos of your before appearance or explain why you underwent upper lid surgery.  For a full assessment this information is required.
  • As you look young, I expect you are looking for a lasting result from the proposed correction. Using your own fat to restore volume is preferred, but a second procedure may be required. Other than that fat injections are safe, but with traditional technique there is the possibility of visible fat lumps, even with meticulous technique.
  • This is the reason I use the Lipogems technique as with that there is no suggestion of lumps,  in the 150 cases I have done      in the 18 months

Melbourne Plastic Surgeon
4.9 out of 5 stars 39 reviews

This is fixable but not with grafted fat.

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The surgeon who recommended moving the crease is more on the right track but you need more information.  Very few surgeons in the world understand these methods so you need to be highly skeptical or you will have a failed revision with fewer resources left to ultimately fix the eyelid.  Everything that mades an upper eyelid has to do with the many layers that glide over each other inside the eyelid.  Grafted fat scars these planes.  The eyelid may be full but it will no longer function and the results of these surgeries are aesthetically unsatisfactory.  This is true whether one uses dermis fat grafts, fat pearls, micro fat grafts etc.  If the surgeon who suggested moving the crease proposed raising the right upper crease to match the higher left crease, do not go back to this surgeon.  That is not a solution to your problem.  The answer is lowering the upper eyelid crease and fixing the ptosis.  This method is illustrated in the attached video.  This is done with reconstructive surgery: New creases are made at approximately 7 mm.  A small skin excision is made to provide a surgical window which will become the new upper eyelid crease.  Normally the levator aponeurosis will be found at this level but yours will not be found there.  Yours, very much like the woman in the video, is detached in both eyelids.  The tendon needs to be dissected as shown in the video.  It is then used to resuspend the upper eyelid.  An anchor blepharoplasty is performed to attach the cut edge of the eyelid platform to the advanced levator aponeurosis. Anterior orbital  fat held in scar  tissue relate to the prior eyelid surgery  is mobilized and brought forward to fill the reconstructed upper eyelid fold.  That is how the upper eyelids are safely reconstructed.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Eyelid Surgery

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Thank you for sharing your concerns.   In my opinion, fat graft will be your best longterm option
Good luck

Gaby D. Doumit, MD
Montreal Plastic Surgeon

Hollow upper eyelids

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Many surgeons take out significant amounts of fat during an upper blepharoplasty and sometimes patients are left with this hallow look. So to correct this, you need volume. That volume can be in the form of fat or filler, patient and surgeons preference. Fat is more permanent(but you have to harvest it from somewhere), filler is less permanent but can be pulled off of the shelf.

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