Upper Eyelid Fat Grafting for Deepset Eyes?

Question

I have deepset eyes, but over the last couple of years it has gotten worse.  Also the skin between my eyes and nose, and my eyelids, has gotten darker and bruised-looking.  I know that some of this is due to stress, but it doesn't recede much even during less stressful times.  What can I do? Do I need upper eyelid fat grafting?

Michael Law, MD · Answer

In patients that have always had, or who with age have developed a deep recess between the upper lid and brow, the addition of soft tissue volume can dramatically rejuvenate the appearance of the eyes. This novel aesthetic enhancement of the upper lids does not look like eyelid surgery - it just looks youthful.Fat grafting works by expertly injecting very small amounts (less than 0.1 cc at a time) of fat are carefully microinjected in a series of discrete layers to gradually 'build' new soft tissue structure. As there is space between each microinjection, new blood vessels are able to grow into the grafted fat, allowing it to persist. If this process of blood vessel ingrowth (neovascularization) does not occur, then the injected tissue cannot truly be considered a 'graft' and is instead just another 'soft tissue filler' of limited duration.Fat Grafting requires specialized training and specialized surgical instruments, as well as patience and attention to detail on the part of the surgeon. When performed properly, permanent improvements are possible.This is a delicate procedure that requires meticulous attention to detail. Find a plastic surgeon with a lot of experience with fat grafting and many photos of fat grafting to the upper eye area for you to view.

Sam Naficy, MD, FACS · Answer

The deep-set nature of your upper eyelids is in a large part due to eyelid ptosis.  Fat and fillers can be used in the upper eyelids and fillers are probably safer

Otto Joseph Placik, MD · Answer

There have been artilcles written about this technique. However, this is an area that may be prone to visibility of the grafts. A variety of techniques to limit this possiblity include microfat grafting, lumbrical grafts (sausage shaped), staged placement, etc.
In my opinion, I am not a fan of this technique for your condition but you may want to visit some plastic surgeons who advocate this technique.

Peter A. Aldea, MD · Answer

I agree with Dr. Placik. The success to failure ration in fat grafting to the upper lid is small and failed fat grafts in this area are known to form palpable and visible nodules which mar need to be incised.
Another thing you may want to look into, you appear to have Bilateral Levator Dis-insertion / dehiscence. In other words, your lower lids are coming down more than they should resulting in a sleepy tired look and a largely missing transverse upper lid crease (where this muscle attaches to the skin and Tarsal plate(cartilage stiffener) below. This can be fixed by an Oculoplastic or Plastic surgeon and MAY be covered by your insurance.
Good Luck.
Dr. P. Aldea

Richard P. Rand, MD, FACS (retired) · Answer

As Drs. Aldea and Placik have said, fat grafting is not as easy as it sounds to the upper lids. Your photo does show eyelid ptosis and you should go to a skilled oculoplastic surgeon for repair. Just with this, you will look better.

Upper Eyelid Fat Grafting for Deepset Eyes?

Answers (5)

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