What is the cause of sunken upper eyelids, and how can I treat them?

Sunken upper eyelids/Upper eyelid hollowness can be due to the following:

1. Genetics

2. Aging-related atrophy/loss of upper eyelid fat tissue

3. Iatrogenic causes such as post eyelid surgery volume loss, especially eyelid surgeries that were done in the past where surgical techniques and equipment were not as advanced as recent years.

4. Aponeurotic ptosis where there might be thinning of the upper lid, deepening of the eyelid sulcus and a raised upper lid crease resulting in the upper eyelid loking sunken/hollow.

Treatment options will include:

1. Filler injections to correct the hollowness/volume deficit by an experienced doctor who is proficient with fillers over this area of the face

2. Fat grafting or transpositioning of upper eyelid fat pads by a plastic surgeon

3. Surgical repair by an eye surgeon if it's due to aponeurotic ptosis of the eye

The most common cause of sunken upper eyelids (or upper eyelid hollowness) is due to Aging-related soft tissue and bone loss.

The other causes of sunken upper eyelids are due to genetics and post eyelid surgery volume loss.

Treatment options will depend on the exact causes/s of your sunken upper eyelids. It is best to be assessed in person by an experienced aesthetic doctor.

Hollowness (aka Volume Loss) will require Filler injections to correct the hollowness/volume deficit. This is a challenging region of the face so please look for an experienced Filler injector for best results and to minimise complications.

Depending on which filler is being used, results can last from 9 to 18 months.

The choice of fillers is also dependent on the severity of your volume loss.

Alternatively, Fat grafting of upper eyelid fat pads by a plastic surgeon can also be performed.

Hope that this helps!

Warmest regards,

Dr Justin Boey

Great question. This is a not infrequent complaint that I hear of. The most common reason is that of orbital fat atrophy that occurs as a normal ageing process. Secondary causes include previous orbital trauma, orbital wall fracture, or ptosis (drooping eyelid).

The treatment is primarily to address the root cause (for example, orbital wall fracture repair, orbital volume replacement or ptosis repair). If all other secondary causes are excluded, a straight forward supra-periosteal injection of hyaluronic acid filler or micro-fat injection to the superior sulcus will help to disguise this upper lid sulcus depression to restore a youthful and fresh appearance.

Best of luck with the treatment choice that you make!

ESG