Blepharoplasty, also known as eyelid surgery, aims to improve the appearance of the upper and lower eyelids. While it can successfully reduce excess skin and fat that contributes to droopy or baggy eyelids, one potential side effect is a hollow appearance around the eyes. This occurs when too much fat and tissue is removed during surgery. Thankfully, there are a few ways to fix hollow eyes after blepharoplasty.
What causes hollow eyes after blepharoplasty?
Hollow eyes or sunken eyes after blepharoplasty are caused by excessive removal of orbital fat and tissue during surgery. The delicate fat pads around the eyes provide structure and support. Removing too much fat creates empty space and can alter the shape of the eyes, leading to a sunken, hollow look.
According to the American Society of Plastic Surgeons, the most common causes of hollow eyes after blepharoplasty include:
- Over resectioning of fat pads under the eyes during lower blepharoplasty
- Aggressive excision of orbital fat during transconjunctival blepharoplasty
- Removing too much skin and muscle from the upper lids
In many cases, eyelid hollowness after surgery is temporary and improves within a few weeks as swelling subsides. However, a sunken eye appearance that persists months later usually indicates too much tissue was excised.
Non-surgical treatments for hollow eyes
For mild hollowness, there are several nonsurgical treatments that can potentially improve the appearance of sunken eyes after blepharoplasty:
Facial Exercises
Performing facial exercises to strengthen the orbicularis oculi muscle around the eyes may help “fill in” a mildly sunken eye area. Try simple movements like gently squeezing eyes shut, looking side to side, and blinking rapidly.
Eye Creams
Using skin plumping eye creams containing ingredients like hyaluronic acid can temporarily hydrate and fill in hollows under the eyes. However, results are usually subtle as creams only work on the skin’s surface.
Injectable Fillers
Injectables like Juvederm and Restylane can be strategically injected along the under eye area to add volume and fill in hollows. Results from fillers tend to last 6 to 9 months. However, the effect is still temporary and maintenance injections are needed.
Fat Grafting
Fat grafting involves harvesting a small amount of fat using liposuction, usually from the thighs or abdomen, then meticulously re-injecting the fat into the hollow eye area for more permanent filling. The transplant also utilizes the patient’s own tissue so there is no risk of rejection.
Surgical treatments for hollow eyes
For significant hollowness after blepharoplasty, surgical intervention is usually required to properly reconstruct the fat pads around the eyes.
Autologous Fat Transfer
Like fat grafting, this procedure involves harvesting fat from elsewhere in the patient’s body then reinjecting it around the orbital rims and above the cheekbones to fill sunken areas. The advantage of this surgical technique is the surgeon can expertly position larger amounts of fat in the appropriate locations during the operation.
Lower Eyelid Retraction Repair
If hollow eyes resulted from lower eyelid retraction or malposition after previous blepharoplasty, the surgeon can release restrictive scar tissue then reposition and reinforce the lower eyelid. This readjusts eyelid anatomy to help resolve under eye hollowness.
Custom Facial Implants
For significant hollowing or volume loss, plastic surgeons may opt to place custom designed implants over the orbital rims to structurally augment the sunken area. Various implant materials can be used like silicone, acrylic, or Medpor. Implants typically produce permanent augmentation.
Temporal Fat Grafting
Fat harvested from the temple area tends to have better viability. Temporal fat grafting involves transplanting fat from the temples to the under eye region. The more robust fat cells can better replace volume loss compared to fat from other areas.
Risks and complications
As with any procedure, there are some risks to be aware of with treatments to repair post-blepharoplasty hollow eyes:
- Infection
- Adverse reaction to anesthesia
- Fat graft failure or fat reabsorption
- Asymmetry in surgical repair and results
- Implant extrusion
- Need for revision surgery
Recovery and results timeline
Recovery time varies based on the specific technique used to treat hollow eyes, but patients can expect:
Injectable fillers
- Minimal to no downtime
- Results visible immediately
- Lasts 6 to 12 months
- Maintenance injections needed
Fat grafting or fat transfer
- Swelling for 2 to 4 weeks
- Results may continue improving over a few months
- 50% fat reabsorption common so some touch up injections usually needed
- Lasts 1 to 2 years on average
Lower eyelid surgery
- 1 to 2 weeks recovery
- Stitch removal around 1 week
- Most swelling resolves in 4 to 6 weeks
- Final results at around 3 months postoperative
Custom orbital implants
- 1 week recovery
- Swelling and bruising for 2 to 3 weeks
- Stitches removed in 1 week
- Implants are permanent
Prevention
The best way to prevent a sunken, hollow eye appearance after blepharoplasty is to take great care in removing fat during the initial surgery. Experienced oculoplastic surgeons know how to judiciously resect tissue to avoid hollowing while still achieving aesthetic results.
Other tips that can help prevent hollowing include:
- Avoiding aggressive fat removal during transconjunctival blepharoplasty
- Leaving behind some orbital fat pads when possible
- Performing fat grafting at the same time as eyelid surgery
- Starting with more conservative amounts of skin/muscle excision then removing more as needed
Takeaways
- Hollow eyes after blepharoplasty are caused by over-resectioning of fat and tissue during surgery.
- For mild hollowing, nonsurgical injections, fat grafting, or facial exercises may provide improvement.
- Severe hollowing requires surgical correction such as eyelid surgery, fat transfers, or custom orbital implants.
- Careful, conservative excision of fat during the initial blepharoplasty can help prevent hollow eyes.
- Proper surgical revision can successfully restore lost volume and correct sunken eyes after blepharoplasty.