Although it has yet to be proven that certain laser treatments can accelerate facial volume loss, anecdotal evidence shows that especially around delicate thin skin such as around the eyes and temples lasers might accelerate facial volume loss. It is normal to lose facial fat with the normal aging process so it would be hard to tell what is truly causing the facial volume lose or the loss of fat round your eyes. Unless there is a controlled trial where a laser was only used on one half of the face we might never know!

People with orbital fat loss or hollowing around the eyes usually state that their eyes actually look better when they wake up in the morning and they are puffy. As the day progressed they state that they eyes look worse and more tired and hollow.

It is possible to address this orbital volume loss and hollowness with injections of either fat or fillers.

Orbital fat loss is probably the most important contributor to the aging of our eyes. In some people it leads to hollowness while in others it leads to loss of support of the brow and upper eyelid with resultant sagging and drooping. Adding volume is the most effective and most natural way of making the eyes look much more youthful, while also adding support to the eyelids leading to better eyelid function. Some people with complaints of dry eyes actually can benefit from adding volume and hence support around the eyelids. This might improve their dry eye problems.

What is the best way of adding volume? Fat or fillers such as restylane? Both can be effective and can have similar results. I routinely use both so can speak of the pros and cons of each. Fat injections can work very well in the upper eyelids. It is a bit less effective and can have more issues in the lower eyelid with potential for lumps. In the upper eyelids there could also be lumps from it but it is less of an issue. Fat injections are not the most predictable way to add volume because of the variable of how much fat will actually "take" in each area. It is not uncommon that a touch up will need to be performed several months after the first procedure.

The advantage of using fillers include ease, short recovery times, and much higher predictability that fat injections around the eyes. It takes just a few minutes to perform and you are set to get back to life as soon as the procedure is over. There of course can be some swelling and occasional bruising from filler injections around the eyes, but it is usually significantly less than fat injections for orbital fat loss. Fillers, of course, are not permanent, or at least Restylane isn't. In my experience filler injections around the eyes last a long time, sometimes several years, especially in the upper eyelid.

Both fat injections and fillers are great ways to add volume and support around the eyes for orbital fat loss. During your consultation the specifics of each will be discussed.

To learn more about orbital fat loss and eyelid surgery please visit our Eyelid Surgery page.

By Gal Aharonov

Restylane in the upper eyelid stays longer than in pretty much any other place on the face. I routinely see patients back after longer than a year and the upper eyelid filler is still looking good with hardly any need for a touch up.

Because of the fact that filler lasts such a long time in the upper eyelids, combined with the precision and accuracy of the fillers, I believe it should be the treatment of choice in restoring upper eyelid volume over the use of fat. I think fat injections are more useful when it comes to total face rejuvination and are not worth the investment when only one small area such as the upper eyelids is to be treated. Fat injections are also not as predictable as the fillers thus necessitating possible touch ups and tweaks in the future.

Below is an example of a patient before and 3 YEARS AFTER Restylane injections into the upper eyelids to restore volume and correct an asymmetry caused by a previous eyelid lift by another surgeon.

Click here to view more before and after photos of upper eyelid fillers

By Gal Aharonov

Endoscopic browlifts are well known for causing these effects you describe when done too aggressively. Browlifts, in my opinion, are overperformed and do not always give a very natural result. So what options do you have now to fix your issues?

It is possible to reverse the procedure. A reverse endoscopic brow lowering surgery can be performed to lower your brows back down. If you are nervous about surgery again and would prefer something less invasive, it is possible to reduce the hollowness in your eyes and make them less round with just filler. This will not lower your brows but injecting filler below your brow can take away the roundness and hollowness. This also reduces the "deer in the headlights" look BUT does not lower the brows.

Either restylane or juvederm can be used to inject into the brow and upper eyelid. I prefer restylane because it seems to not swell as much as juvederm. Filler into the upper eyelid and brow area lasts a very long time. I have patients where it has lasted well over 2 years!