Follow up to my previous question: Upper eyelid folds due to volume loss (Photo)

Your issue is that you are developing upper eyelid ptosis and you have a bit of extra skin.  The ptosis is an early levator dehisence ptosis.  At the tendon separates from its attachment in the upper eyelid, the eyelid margin becomes heavy, also the anterior orbital fat tends to retract into the orbit making the upper eyelid sulcus a bit more hollow.  This is compounded by a compensatory eyebrow elevation.  Correcting the ptosis at the time of an anchor blepharoplasty will make a big difference.  Study my microdroplet botox method.  This would be helpful for you but it is not a substitute for eyelid surgery.  Remember that fat grafting is a surgery and unfortunately it creates scar tissue where it is placed.  That does not always lead to a wonderful result.  Hyaluronic acid fillers can be removed if the need arises.

I would try it with some type of HA first to make sure this is what you are looking for. It is so much easier to dissolve the HA than the fat if you don't like the result of the injections in the upper eyelids with HA.

Dear Samforu,

Thank you for your clinical post and
photographs. The pictures of you four
years ago show an eyelid that does not have any drooping or ptosis. Ptosis occurs when the eyelid lifting muscle
of the levator aponeurosis begins to separate from this dermal attachment and
leads to a droopiness of the eyelid.
There is then some excess skin and tissue at the junction of the
dehiscence and this can be improved moderately with a small amount of Botox in
either side of the leading ciliary lash line together with some soft tissue
fillers in the supratarsal fold and Botox brow lift. Levator repair and blepharoplasty is your
best option, however, this is surgical.
Be careful if using a filler alone as the added weight on the upper lid
if not injected in the right location can make the eyelid droop ptosis and
narrowing of the eye worse.

Usually there’s no magic bullet fat
grafting to the upper lid although it works as a delicate technique and not
terribly forgiving and you need to make sure that you’re seeing an expert. When you have a definable anatomical
abnormality such as levator ptosis and eyelid droop, surgical restoration is
usually your best result.

I hope this information is of some
assistance and best of luck.

To find out more, please visit the
link below. Also visit the soft tissue filler areas.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto