Hollow Upper Eyelids (or lower eyelids for that matter) can safely and effectively be treated with structural fat grafting when performed by a plastic surgeon with extensive experience and expertise in this area. No other filler should be used for the correction of hollow eyes.
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.
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.
M.M. Law, MD
