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Can fat be injected into hollow upper eyelids?

Q:

I have hollow looking eyes after a blepharoplasty procedure.  My excess skin is gone but I feel like I look much older now than before my surgery.  Can my hollow upper eyelids be corrected with fat injections?

A:

Fat grafting can be performed in the peri-occular area to correct the effects of aging such as hollow eyes.  It is very important to find a qualified practitioner with experience in this particular aesthetic procedure.  The procedure must be conducted in a very specific manner to produce a favorable outcome.  Start by looking for an ASAPS member in your area.

Gary R. Culbertson, MD, FACS

A:

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.

 

A:

Injection of fat into the eyelids is becoming quite frequent because of the previous method of Blepharoplasty that removed the fat combined with the natural tendency to lose fat with age. Seek someone with experience with rejuvenating this area and fat injection as this area requires significant expertise and finesse.

A:

After a traditional blepharoplasty, where fat and in many times muscle was removed, this has resulted in hollow eye syndrome. Recognizing this fact along with the understanding of aging and the loss of fat with age, most plastic surgeons now remove no muscle and are very conservative and selective in removing fat.

To correct the hollow eye, fillers or fat can be transferred to the hollow upper lid.  This requires extreme expertise and understanding from the patient that it may need more than one procedure, mainly because of the difficulty of the procedure and the scarring from previous surgery.

The fat cells need to be very small, and injected using a blunt very thin cannula.

Other methods involve actually reopening the old blepharoplasty incision and grafting fat directly - a string of fat is grafted and the incision is closed.

A:

Fat and Correction of Hollow Eyelids – It is very common to use filler or fat to correct some of the hollowing, however this must be done very carefully and cautiously and a small amount placed just in the upper brow/eyelid area. Otherwise, it will not look normal.

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