Not All Hollowing Is a Volume Problem
Upper eyelid hollowing is often treated as a simple volume deficiency.
In many cases, this leads to the use of fillers or fat grafting.
However, not all hollowing is caused by true fat loss.
In some patients, the appearance of hollowing is the result of structural imbalance,
rather than an actual lack of volume.
When Structure Is Not Addressed
If ptosis is present and not properly corrected,
the eyelid continues to rely on compensatory mechanisms.
The brow elevates,
the skin stretches,
and the hollow appearance becomes more pronounced over time.
In these cases, adding volume alone does not solve the problem.
The Role of Proper Dissection and Correction
Correcting these cases requires more than surface-level intervention.
Adequate dissection and proper ptosis correction
are necessary to restore the underlying structure.
Only when the eyelid is released and repositioned appropriately
can the true relationship between function and volume be addressed.
This is not a procedure that can be approached superficially.
When Volume Should Come From the Patient
When volume restoration is needed,
the most reliable source is the patient’s own orbital fat.
Orbital fat repositioning allows volume to be restored
without introducing foreign material or relying on unpredictable graft survival.
This approach, often used in upper eyelid fat repositioning, maintains vascular integrity
and produces a more stable and natural result.
Why Some Results Hold Over Time
In this case, a portion of the hollowing was addressed
through orbital fat repositioning.
However, the primary correction came from proper ptosis surgery.
At 6 months, the result remains stable.
This stability reflects not the addition of volume alone,
but the correction of the underlying structural problem.
What Leads to Poor Outcomes
When the cause of hollowing is misunderstood,
treatment often follows the wrong direction.
Common mistakes include:
• adding filler to a structurally unstable eyelid
• performing fat grafting without addressing ptosis
• creating a higher crease to mask hollowing
• avoiding proper dissection or relying on non-incisional methods
These approaches may produce temporary changes,
but often lead to long-term instability.
Not All Eyes Can Be Treated the Same Way
Some eyes cannot be fully corrected
without addressing both function and structure.
The goal is not to fill what appears empty,
but to understand why the change occurred in the first place.
Without this understanding,
treatment becomes repetition—not resolution.
Internal References
→ See ptosis correction cases
Seeing the Eye as a Whole, Not in Parts
A Clinic Dedicated to Eyelid Revision Surgery in Korea
Ahnsungmin Plastic Surgery