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I regularly perform this procedure and have injected my own upper eye area, but not the actual eyelid that covers the eye when you blink. If your looking to pull a little loose skin from the eyelid your going to need your whole "orbital frame" injected. This would include your temples and brows. As we age we lose fat in those areas and they sink in causing the skin to start pooling on the eyes. At a certain point no amount of filler is going to correct it, you'll need surgery. However, if it's just starting or not too bad you'd be amazed at what can be done.
Although doctors and surgeons who inject fillers are a dime a dozen, it seems that injecting fillers for the upper eyelid hollowing is not very common. I first became interested in upper eyelid hollowing in 2006. Initially I was not using injectable fillers back then, and instead was using fat grafting, using Dr. ******'s Pearl Fat Grafting technique. This give very nice results, but once the fat is grafted, it cannot be easily removed. This technique requires an incision to graft the fat. Skin can be removed at the same time; however, it does not require skin removal to perform Pearl Fat grafting.
In 2008, I had a patient with severe upper eyelid hollowing and crepey upper eyelid skin. I thought she would be a good candidate for the Pearl Fat Grafting. However, she was afraid of getting the upper eyelid incision, because she tends to keloid. In general, the chance of keloiding from an upper eyelid incision is very rare, but I did not want to take that chance. I considered using Restylane to fill the area, but before I committed to the Restylane, I performed a Saline Simulation, or Water simulation, by injecting saline and numbing medicine to show her the effects of volumizing the brow skin. She really liked the simulation, so a couple weeks after the Water simulation, I performed my first upper eyelid filler using Restylane in 2008.
In general, the types of patients who tend to get this procedure are younger patients who appear to have a slight bit of upper eyelid skin excess, but simulatenously have an increase in upper eyelid platform showing as compared to photos of themselves when they were younger. They may also have an A-frame deformity or doll's eye deformity, where the upper eyelid skin appears be be vacuumed inside of the eyesocket. Although this vacuum effect prevents the upper eyelid from "hooding" it tends to make the eye look older.
Here is an example of a before (age 35) and after (age 38) photo of upper eyelid filler for upper eyelid hollowing. Although this woman's eyes are beautiful, she felt that her eyes looked older and sunked in. The increased eyelid showing looks nice, but we do not know how she used to look when she was younger. Below is a close up photo of the same woman when she was 17 and modeling. The goal of the upper eyelid filling was to try to simulate her younger eyelid "configuration" as much as possible. I think the key photo which will help determine whether an injector is skilled at performing upper eyelid fillers is a view of the patient looking downwards. If the upper eyelid filler is injected properly, it should look very smooth when the patient is looking downwards. If it is lumpy, then the injector may be injecting it in the wrong place. Image Credit: GeorgeYangMD.com
I think the concept of adding volume around the frame of the eye is beginning to catch on. It first began many years ago with lower eyelid/tear trough filling. Now it is periorbital filling which blends the upper cheek with the lower eyelid area, to create a single convexity or a single curve below the eyelid blending into the cheek. The double convexity is when the lower eyelid bag, is separate from the beginning edge of the cheek.
Now there seems to be new articles discussing the upper eyelid hollowing even in plastic surgery journals. They discuss how a flatter and fuller brow has become more in style and the browlifted appearance with the angled arched brow. I think this look is "authentically" more like the way that these patients actually looked like when they were younger.
In summary, if there is too much eyelid showing, and the appearance of "excess upper eyelid skin", with a decrease of skin showing below the eyebrow, these patients are potentially good candidates for upper eyelid fillers alone. If there is hooding or hanging of the upper eyelid skin, adding upper eyelid fillers may make the hooding even worse. These patients still benefit from a conservative upper eyelid skin removal, but may also benefit from adding volume to the brow skin below the eyebrows. This can be done with either fat at the time of the surgery, or a couple of months later after the blepharoplasty to allow all of the swelling to dissipate.
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