Upper Eye Hollowness with Ptosis. What Do You Recommend? (photo)

I am a 26 year old male. The photo I have taken is with my eyes in their natural position. I can hold my eyes open more, which I do in public, but it becomes a strain after a while. I am also concerned about the fat loss above my eyes and near my nose. Would I benefit from ptosis surgery and something like restylane filler? What about restylane in my temple area? I feel like my eyes have a harsh, empty appearance and they're not very inviting socially. Thank you in advance.

Doctor Answers 8

Ptosis surgery

The cause of your ptosis would first need to be addressed before any surgical plan is established, as there are a number of circumstances that may lead to the condition. 
In general, an upper blepharoplasty will help to correct the appearance of the droopy upper eyelids. If the eyelid is droopy, it can be eyelid ptosis. Typically, as an individual ages, they may experience a drooping brow along with excess skin over their eyelids.

If you feel there is hollowness above your eyes, the condition will improve following a ptosis repair.  As for hollowness in the tear trough, fat repositioning or a filler such as Restylane will yield a fantastic result.  The fat transfer is a more permanent option, and the fat typically has around a 30% take. To start, I would recommend a consultation with a board certified opthamologist to help determine the cause of your ptosis. Thank you and I hope this helps.

Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 47 reviews

Ptosis Canidate

Thank your for the photos. I believe you are a good candidate for ptosis surgery. I would recommend you have that done first before considering any volume augmentation. You may find that having more open eyes will be socially inviting enough.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 72 reviews

Eyelid ptosis and temporal hollowing

Dear Burbank3685

If your droopy eyelid and your temporal hollowing have been progressive, there is a condition that needs to be ruled out called Myotonic dystrophy. There are some other health considerations that come along with this disorder.

As far as treatment for your eyelid ptosis and temporal hollowing goes: yes, there are options to consider. Depending on your eyelid movement, there are different techniques that can be considered to help raise your eyelids [left more than right]

For your temporal hollowing, fat grafting or Sculptra injections are more appropriate than Restylane.

 I would recommend consultation with an ASOPRS trained Oculoplastics surgeon. You can find one close to you on the ASOPRS dot org website.


A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 41 reviews

Upper eyelid ptosis and hollowness

You do have upper eyelid ptosis, left greater than right.  You also have hollowness.  The hollowness can improve by doing the ptosis surgery because tightening the levator muscle and lifting the eyelid will fill the upper eyelid hollow area somewhat so I would recommend you do that before filler injection.  See an oculoplastic surgeon.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 74 reviews

Ptosis and hollowness

  I like the answers you received thus far.  I would like to second the advice you received to address the problems separately.  Depending on what bothers you most, I would address the ptosis first.  Later, the eye hollowness could be addressed with an HA filler and the hollowness in the temple with Radiesse or Sculptra, and I certainly second the need to seek out an oculofacial specialist in your area.

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon
4.9 out of 5 stars 134 reviews

Ptosis and hollowness

Go see an ophthalmic plastic surgeon. First eliminate other causes of ptosis especially since your pupils are unequal. Then the ptosis can be addressed surgically. Any residual hollowness on the upper lid can be improved with Juvederm injection. Temporal hollowness responds well to fat grafting or injection of Radiesse or Sculptra.

Peter T. Truong, MD
Fresno Oculoplastic Surgeon
4.9 out of 5 stars 38 reviews

Upper Eye Hollowness with Ptosis. What Do You Recommend? (photo)

It looks like you are a candidate for ptosis surgery and fillers.  You should see an Oculoplastic surgeon to evaluate you to see if you are a good surgical candidate.

Sam Goldberger, MD
Beverly Hills Oculoplastic Surgeon
4.7 out of 5 stars 16 reviews

Ptosis and other issues.

Hello Burbank,


My first question is two part:

1.  Is there a medical reason for the temporal waisting?

2.  Did the hollowness come on later in life or was it always there to some degree?


Having some hollowness is not unusual with ptosis as the levator muscle (and other tissues) are not really present in the space between your lid and orbital bone.  What you'd find after ptosis repair is that the hollowness would improve a bit.  Not everyone is qualified or experienced enough to perform this at the same time but when your ptosis repair is performed you can have fat or tissue grafting to the upper eyelid to further improve that hollowness.  You need a good evaluation with an ophthalmologist to determine the cause of your ptosis.  This will determine your odds for success.  Just a note, from your photo is looks like the worst is the left, no surprise but if that one is repaired alone the right will drop.  It's called Hering's law.   It's normal but needs to be addressed either at the same time or with a second procedure.


Now for the temples.  If you're a thin guy with no fat for fat grafting you can have temple implants or Sculptra would be good options for you.


Best of luck


Chase Lay, MD


Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 76 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.