Upper Eyelid Hollow? (photo)

Dear AsianPersuasion

Thank you for your question!  The cost of this procedure will vary- However this is a procedure that should be done by a very qualified injector with an eye for aesthetic contouring and facial shaping.

With Warm Regards,

Trevor M Born MD

Upper eyelid hollowness is a dramatically underappreciated, yet incredibly important component of aging in the eyelids. With normal aging, our upper eyelid fat pads tend to retract and expose this upper lid hollowness, those with “deep set eyes“ are especially prone, and unfortunately old-school upper eyelid surgery that is overly subtractive can artificially create this hollowness early, actually looking worse than it did before surgery - the before and after photo in the link below resulted from overly subtractive upper eyelid surgery with another surgeon, and you can see the results after revolumization of the upper lids. Correcting this hollowness can happen with filler injections into very specific planes of the upper eyelid, or transposing and rearranging the upper eyelid fat pads to provide fullness, as you see in this surgeon’s view video, borrowing the excess fat to move into the areas lacking fullness!

 

Upper eyelid hollows respond well to the injection of volumizing fillers, such as Belotero Balance. Belotero Balance, a hyaluronic acid based filler,has the advantage, due to certain unique aspects in the product's manufacture, to allow it to be injected even in thin areas around the eyes with little concern for the development of a bluish discoloration of the skin seen with other hyaluronic acid injectables that may occur as a result of light scattering. Although I prefer Belotero for this purpose, Restylane L and Juvederm UltraPlus XC have likewise been used successfully for this purpose. The cost will vary according to which material is used and the precise amount injected.

In the hands of an experienced injector, the replacement of volume in this region fills out the hollowed area restoring more aesthetic proportions between the upper eyelid and the lower portion of the brow.  If desired, a test injection of a small volume of salt solution may be used to give an approximate idea of what the final result might look like following actual treatment. Treating areas around the eyes should only be performed by physicians with considerable experience in injecting this location.

Improving upper eyelid hollows with injectable volumizers seldom takes more than five minutes per side.

 

I have filled this upper eyelid hollow utilizing either fat grafting or Restylane.  Since this is a pretty static part of the face Restylane can last quite a while in this area.  

Thanks for the pictures.  I see your concern.  I would not recommend Restylane in that area.  Fat grafting over time may give you some correction..  Seek consultation from BC plastic surgeons or facial plastic surgeons.

Dr Es

If the issue is simply loss of volume in the upper eyelids, then either hyaluronic acid fillers or a small amount of your own fat can be used to fill the hollow area. Hollow upper eyelids most often result from overly aggressive upper blepharoplasty but can occur naturally. Seek a consultation with a Plastic or Oculoplastic Surgeon for more specific advice. I hope this information is helpful.

Stephen Weber MD, FACS

The area between the brow and the upper eyelid crease is full of subcutaneous fat in most young people, and that fullness looks youthful.   I refer to this area as the "brow-upper lid junction," and I add fat to make it fuller in the majority of patients for who I perform eye-area rejuvenation surgery.  Take a look at the eyes of fashion models in advertisements: in most cases you actually see little to none of the upper lid.  What you see is a youthful soft tissue fullness that extends from the brow to the upper lid lashes.
As we age, this fatty fullness atrophies and the brow-upper lid junction gradually becomes hollow.  The outline of the bony structures below the brow (the superior orbital rim) becomes visible, and one begins to look older, sometimes even ill, and in advanced stages even skeletal.  In some patients that I treat this appearance is inherited and they have a hollow look at their brow-upper lid junction at a young age.  Whether it is something that was always present, something that has developed with aging, or the result of an overly-aggressive upper blepharoplasty, fat grafting of the brow-upper lid junction can rejuvenate the eye area in a manner that is simply impossible by means of standard blepharoplasty techniques.  It does not look like ‘surgery’, and patients for whom I perform this procedure return to say that their friends and acquaintances think they look great, but they can’t quite put their finger on why. A word of caution: this is a delicate surgery that requires a fair amount of experience with fat grafting, and meticulous surgical technique.  In experienced hands a smooth, youthful and aesthetically ideal brow-upper lid contour can be achieved.  Make sure your surgeon can show you numerous photographic examples of brow-upper lid junction fat grafting.

Restylane is a very temporary filler I recommend fat grafts after Dr Coleman's techniques of micro droplets. 

Yes, sometimes filler can be placed to provide some more fill to the upper eyelid and improve the appearance.

I have been performing Restylane injections to the upper lids for several years now.  It is one of the most gratifying treatments for this area.  It is fast to undergo with minimal swelling and bruising.  The cost runs around $600 and lasts about 1 year.