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.

Unfortunately once fat has been placed it is extremely difficult to try to remove. Sometimes too much volume in the temples and around the eyes can make the eyes seem smaller and more deep set. At times that is desirable especially for patients with bulging eyes or prominent eyes.

At times steroids or 5-FU can be injected judiciously to help reduce some of the fat volume but it is difficult and not very predictable. That is why it is always safer to underfill when it comes to fat or even fillers for that matter. It is always easier to put more in than to remove what's there.

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