Section: Fat Loss
Treatment Options for Asian Upper Hollowing
Hollowness may occur either naturally or as a result of various missteps during cosmetic eyelid surgery. Aggressive removal of eyelid skin, orbicularis (closing) muscle, orbital fat, or sub-brow fat, either alone or in combination, can deplete normal eyelid volume resulting in high, deep, multiple, and/or overly rounded creases.
Any eyelid muscle that has been removed cannot be replaced. Missing skin can be addressed by placing a full-thickness skin graft, but healing time is long and the outcome is often cosmetically disappointing. Insufficient sub-brow fat may be helped slightly with the injection of liposuctioned fat but any improvement in eyelid appearance is minimal at best.
In our experience, the only effective method to address moderate to advanced eyelid hollowness is by grafting of structurally-intact fat into the orbit, or deeper space around the eye. While such treatment can help to restore depleted orbital fat, it cannot correct any other tissue deficiencies such as missing skin or muscle. Likewise, deformity caused by external or internal scar tissue from any prior surgery will not be helped.
Thus, the degree of correction of any postsurgical deformity will vary significantly from patient to patient, depending upon the specific nature and severity of tissue loss in each case. Patients with pure orbital fat deficiency on the basis of genetics rather than previous surgery generally do the best.
In patients with eyelid problems caused by multiple tissue deficiencies and scarring, any improvement after orbital fat grafting may be minimal or disappointing.
Mild depressions are best left alone. For more noticeable defects, a realistic goal is to achieve an improvement that looks more natural but not a complete or near-complete elimination of what is usually a multi-factorial problem. With even the most advanced revisional surgical techniques currently available, some complications may not respond in a predictable or satisfactory manner.
Because orbital fat grafting is still relatively new, such techniques are not widely available. Consequently, some Asian patients with natural or surgical hollowness are instead advised that no remedy exists.
Others may be offered treatment by injection of liposuctioned fat aspirate (fat injection) or temporary commercial fillers. Unfortunately, superficial injection yields no lasting help for deeper hollowness, while injection into the orbit is dangerous and ineffective.
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In recent years, surgeons have actively studied, developed, and refined a variety of orbital fat grafting techniques for application in hollowed eyelids. Depending upon the problem, several approaches or combination of approaches for treating Asian upper hollowness may be employed. Such surgery is, however, not widely available:
• Strip Fat Graft Placed Behind an Intact Orbital Septum
This is our preferred method for treating most patients with moderate age-related hollowness who have not undergone previous surgery.
• Pearl Fat Grafts Placed Behind an Opened Orbital Septum
This is our preferred method for treating patients with moderate to severe hollowness or those who have undergone multiple or aggressive previous eyelid operations, especially if simultaneous crease revision is necessary.
• Lower Orbit to Upper Orbit Fat Graft Behind an Intact Orbital Septum
This method is employed in patients with moderate upper hollowness with moderate or advanced lower fat bulging.
• Lower Orbit to Upper Orbit Fat Grafting Behind an Opened Orbital Septum
This method is employed in patients with moderate or advanced lower fat bulging who have undergone multiple or aggressive previous eyelid operations or are seeking simultaneous double eyelid surgery.
• Internal Fat Relocation of Scarred or Trapped Upper Orbital Fat
This powerful but very effective method is used when fat has been entrapped by post- surgical scarring or natural in-born adhesions located in the upper orbit. In some cases, fat relocation may be accompanied by pearl fat grafting to achieve the best result.
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