Case 1107: 34 year-old woman with fair skin tone underwent Restylane injections for Upper Eyelid Hollowing.

Younger photos to compare what changed about her eyes.

Upper eyelid fillers- younger photos for comparison.

In the earlier photo, the distance from the lower edge of the eyebrow to her eyelid crease was about 60-70 percent of the distance of the total distance from the lower edge of the eyebrow to her upper eyelash line. The distance of her upper eyelid platform (upper eyelash line to her eyelid crease) was about 30-40%.

In the latter photo on the right, her right upper eyelid and skin showing below her eyebrow was about a 50:50 ratio, and her left eyelid now shows 60-70% as opposed to 30-40%. The distance from her eyebrow to her eyelashes did not change. Instead the crease simply moved up higher, and showed more eyelid. Often times women actually look more beautiful as they go from their teenage years to their mid-20’s as they show more upper eyelid. However, as this continues, this can result in either hollowing of the upper eyelid which shows more and more upper eyelid, or for people with puffier eyelids when they were young, it can look flat and actually have skin touch their upper eyelashes.

View 1: Before v. Immediately After Injection
Note that the upper eyelid fold is not completely smooth and and still looks a bit uneven after the injection.

View 2: Before Injection v. 1 Year Post Initial Injection
Note that the upper eyelid fold looks smooth and even, and her ratio is about 70% skin below her eyebrow, and 30% upper eyelid platform, like in her youngest photo for comparison.

View 3: Before Injection v. 2 Years Post Initial Injection
Note that she still has continued improvement 2 years after the initial injection, and the ratio is still showing 60% skin below her eyebrow, and 40% upper eyelid platform. Restylane in this area seems to last much longer than in smile lines or lip injections. It is unclear why it can last so long, but the photos show proof of this observation.

View 4: Before Injection v. 3 Years Post Initial Injection
Note the skin below the eyebrow has deflated as compared to the appearance a year ago, and the ratio is about 55% skin below the eyebrow and 45% upper eyelid platform. It is just showing slightly more skin below the eyebrow, than the actual eyelid. At this point in time a small fraction of the original filler was added to both sides, to maintain the result, but not to reinflated the area back to the initial injection or even the 1 year mark, since we both agreed that she looks even better now than she did in the first year after the injection. In our discussions, we both felt that the puffier eyelid did look younger, but she looks more beautiful with the most recent ratio. The goal now is just to maintain this appearance, and not try to increase the ratio all the way back to 70%:30%. One possible reason her upper eyelid filler with Restylane lasted so long was that in retrospect she looked a bit puffy at the year one photo as compared to her year three photos. Since she had more filler on her initial injection it seems to last much longer. If only her 1 year result looked like her 3 year result, then she may have needed a touch up at the 1 or 2 year mark, to maintain that appearance/ratio.

Sometimes women look more beautiful in their 30’s than they did in their 20’s. Looking at their younger photos, they may even feel their faces look a bit too full, and their upper eyelid/brow area looks puffy. The goal of upper eyelid fillers is not to make the eyes puffy, but to find the right balance of when the patient felt they looked their best.