Upper eyelid retraction is when the upper eyelid is raised showing more of the white of the eye and causing the eye or eyes to seem bigger and angrier. This could be due to many reasons. A common reason is from Grave's disease or other thyroid ailments. Patients with upper eyelid retraction can have a surgical correction to try to release the upper eyelid and close it a bit. There is a nonsurgical alternative to mild upper eyelid retraction that can be done with a few quick injections.

This is a question I have been asked many times, and seems to be a common concern in the general population. This concern stems from just a couple of cases that have been reported in the medical literature about blindness occurring after injection of filler around the eyes. This is something I have never seen in my own practice. Why could this have happened? Well, there are theories concerning the filler accidentally being injected right into a major vein that also connects to the eyeball. I do know that injection technique is extremely important especially around the eye. Sometimes I have been shocked by witnessing extremely poor injection technique by some physicians and nurses. Fillers are tools for technicians to use. Poor technique is truly the reason for the majority of complications. Some complications like bruising and swelling are sometimes inevitable and luck based. Lumps should rarely occur if injected well. Again, I have injected thousands of eyes and have yet to ever witness a major issue like blindness. Is it possible? Sure. But I would put the probability at an extremely low level in an experienced injector's hands.

It is possible to do a blepharoplasty (upper eyelid surgery) and at the same time add volume to the upper eyelids and brows. Natural aging consists of volume loss in the brow pad and upper eyelids. Sometimes there is also increased laxity or relatively too much skin which ideally would be trimmed away as well. Depending on the particular case, sometimes a blepharoplasty is needed, sometimes just filler, and sometimes a combination of the two.

This could vary from person to person and from issue to issue. There are different reasons to inject filler around the eye such as under eye bags, under eye hollowness, upper eyelid hollowness, and upper eyelid laxity and droopyness. Filler needs to be injected in different ways to correct each of these issues. That is why there is no standard way to inject filler that is applicable for every issue.

Different people will react to filler differently. Some might swell a large amount, some might not swell at all. Some will not bruise at all, some might have significant bruising. Sometimes it is just luck, other times people might have a propensity to swell or bruise.

It also takes filler a few weeks to soften up and feel more natural. In thicker skin areas this is not a noticeable issue, but around the eye the filler might be palpable and sometimes noticeable for a few weeks.

Injections around the eyes should be taken as seriously as surgery at times. True, a majority of people will look great almost immediately and not have any problems, but a small number of people will have significant swelling and bruising. Make sure you are mentally prepared to maybe be one of those people before deciding to have injections around your eyes. Just because your friend came to me and looked amazing the next day doesn't mean that you are guaranteed to have the same result.

It is very common to have a slowly developing asymmetry to certain parts of the face. The upper eyelid is a very common place to see asymmetries that were not present at a younger age. Patients always ask me why one side is aging faster or losing more volume than the other. A few theories might be that the left side of the face in our country is exposed to more sun while driving. I have had patients that had severe burns on one side of the face when they were younger which sped up the volume loss on that side.

The best way to deal with upper eyelid asymmetries due to volume loss is with filler. Filler is way more accurate than fat or anything else that is currently available. To correct an asymmetry of the upper eyelids usually only a small amount of filler is needed. This can usually be done with just one treatment, but occasionally a touch up might be needed once the swelling settles to get it as perfect as possible.

There sometimes is an asymmetry in the actual amount of upper eyelid skin. If this is the case filler can be used to make the creases appear more symmetric, but the eyes will never be entirely symmetrical unless the superfluous skin is removed surgically.

The biggest indicator of upper eyelid symmetry is the position of the crease, more so than actual volume or amount of skin. The amount of eyelid that is seen is the most critical element. Usually even if there is an asymmetry in the amount of eyelid skin, or even mild ptosis of the eyelid on one side, the eyes can be made to look more symmetrical by adjusting the amount of eyelid show.

To learn more about upper eyelid fillers you can visit our upper eyelid filler page.

In general I can give patients a very good idea of how much filler around the eyes they will need before starting. That is why a consultation is so important. I can give most patients a reasonable idea based on a good quality photograph. Determining how much volume will be needed also depends on your aesthetic goals for what you want your eyes to look like. Some patients desire a very full look while others would just like to fill in some of the hollowness around the eyes.

As a rough starting point, an average patient will need anywhere from 1/2 a cc to 1cc of filler in each upper eyelid. Same goes for the lower eyelid or under eye area. If there is a considerable degree of hollowness you might need as much as 2 cc in each upper eyelid or under eye. This will be discussed during your consultation.

To learn more about fillers around the eyes click here for the eyelid procedures page

Belotero is a new hyaluronic acid based filler sold by Merz. The advantages that I have seen using it is that it is fully hydrated, which means it should not cause as much swelling as the other HA fillers. It also seems to be more liquidy which means it it much less likely to cause any sort of lumps. The disadvantage of that quality is that it is not a good filler for building volume. The other advantage is that it seems, so far, to not cause the tindel effect--the bluish tinge that other HA can cause when injected superficially. This means that Belotero can be safely injected into fine lines, acne scars, and under the eyes without worrying about the bluish tinge.

Disadvantages of Belotero are that it is not a good filler for volumization. The longevity of it in different areas is still not well known.

In my practice I use Belotero for superficial fine lines and acne scars as well as superficial injection under the eye.

Upper eyelid filler lasts longer than almost anywhere else on the face or body. Routinely I have patients for whom it has lasted for over 3-4 years. When it slowly dissipates it usually does so uniformly. This makes upper eyelid filler a really great value for improving one's appearance. You must remember that there will continue to be aging changes taking place over those few years as well, so to maintain the aesthetic result you might want to top off your upper eyelid filler treatment every so often.

The under eye area is extremely vascular and delicate. It is possible to inject filler under the eye while on plavix, but this will certainly increase the probability of a bruise. Since botox is applied very superficially in the skin, there is a much smaller chance of bruising than with restylane under the eyes as that is injected much more deeply.

A Y lift is a trademarked name for placing filler in the face to restore a more youthful facial shape and contour. The concept has been around for years, but the term "Y lift" was trademarked by a dentist in New York a few years ago. Basically filler is placed around the midface, eyes, and chin and jaw area to recreate the shape of the face when it was younger. The theory goes that a youthful face is shaped more like the letter Y and as we age we lose the lateral volume of the upper face which makes our faces seem more droopy. The only thing I find problematic about this is that it promotes a cookie cutter approach to facial fillers and volumization. I believe that for patients who naturally have very high cheek bones a Y lift will only make them appear more gaunt and older looking. A personalized approach is needed for every patient.

Patients need to take the time to do their research. The media loves catchy "new" procedures; it is easy for them to report on and it gets good ratings. Remember that just because something is on television does not make it the "best" thing out there, it just might mean someone has the "best" PR person out there. Sometimes a "new" procedure is just rebranding or trademarking a term for something that has been around for years. Plastic surgery is an investment. Just like with any other investment, the more informed you are about the process, options, and expected results, the smarter you will be and hopefully make the best investment decision.