Upper Eyelid Fat Grafting for Hollow Eyes
Restoring Volume for a Fresher, More Natural-Looking Appearance

By Dr. Penake Thongtong

     Hollow or deeply set upper eyelids are a common concern that can make the face look tired, sunken, or older than it actually is. In some patients, this appearance is related to age-related volume loss around the eyes. Others naturally have deep-set eyes or relatively thin soft tissue around the upper eyelids. Previous eyelid surgery or changes in the eyelid structures can also contribute to an overly hollow appearance.

     For patients with these concerns, Upper Eyelid Fat Grafting can be an option to restore lost volume using the patient's own fat. The fat is carefully prepared and placed in selected areas according to the individual anatomy and overall facial proportions.

      In this article, I will explain who may benefit from upper eyelid fat grafting, its advantages and limitations, preparation, the treatment process, recovery, and aftercare. I will also share a case review in which I chose the area around the umbilicus (belly button) as the donor site for fat harvesting.

What Is Upper Eyelid Fat Grafting?

Upper eyelid fat grafting is a procedure in which fat is harvested from another area of the patient's body, carefully prepared, and then transferred to areas of the upper eyelid that appear hollow, sunken, or deficient in volume.

The goal is not simply to make the eyelid look as full as possible. Instead, the most important step is to determine where volume is actually needed and how much should be added to create balance and harmony around the eyes.

Overfilling can make the upper eyelids appear puffy or heavy and may compromise a natural appearance. Therefore, careful assessment, precise placement, and appropriate technique are essential.

One advantage of using the patient's own fat is that it is the patient's own tissue. It does not carry the same type of allergy concerns associated with certain foreign injectable materials, such as dermal fillers. However, fat grafting also has its own limitations and potential risks, which should be discussed carefully before treatment.


Who May Benefit from Upper Eyelid Fat Grafting?
Upper eyelid fat grafting may be considered for patients with:

Hollow or sunken upper eyelids caused by volume loss
A deep upper eyelid or orbital hollow
A tired or aged appearance related to loss of soft-tissue volume
Naturally thin soft tissue around the upper eyelids
Volume deficiency following previous eyelid surgery
Excessive removal of fat or soft tissue from previous eyelid procedures
However, not everyone with hollow eyes needs fat grafting.

The appearance of hollow upper eyelids can have many different causes, including the underlying bony anatomy, orbital structure, muscles, skin, or eyelid position such as ptosis. A proper examination is therefore important to determine the actual cause of the hollow appearance and whether fat grafting is the most appropriate treatment.

The Upper Eyelid Fat Grafting Procedure

1. Detailed Assessment and Treatment Planning
The first and most important step is a detailed examination of the area around the eyes.

I assess the eyelid crease, upper eyelid contour, orbital anatomy, soft-tissue volume, eyelid position, and overall facial proportions. This allows me to determine which areas have lost volume and how much volume may be needed.

Before treatment, patients should provide a complete medical history, including underlying medical conditions, medications, supplements, drug allergies, and any previous eyelid or facial surgery.

If certain medications or supplements may increase the risk of bleeding, adjustments may sometimes be recommended. However, patients should never stop prescribed medications on their own, particularly medications required for an underlying medical condition. Any changes should be discussed with the prescribing physician.


2. Fat Harvesting
Once the treatment plan has been established, an appropriate donor site is selected. The donor site may vary depending on each patient's individual anatomy and the amount of fat required.

For the case presented in this article, I selected the area around the umbilicus (belly button) as the donor site.

One consideration is that this area can provide an appropriate amount of fat for a small-volume procedure, while allowing the incision to be kept very small.

In this case, I used a technique that allows fat to be harvested through a small incision near the umbilicus, rather than creating multiple puncture sites. Once the wound has healed, the resulting scar is generally very small and often difficult to notice.

As with any procedure, however, wound healing and scar appearance can vary from person to person.


3. Fat Preparation
The harvested fat is processed according to the surgeon's technique before being transferred to the upper eyelid.

The goal is to carefully prepare the fat while maintaining its quality and making it suitable for precise placement in the areas that require volume restoration.

Because the upper eyelid is a relatively small and delicate anatomical area, the preparation and handling of the fat are important parts of the procedure.


4. Fat Placement and Fixation
After the fat has been prepared, it is carefully placed into the areas of the upper eyelid that require volume restoration.

In this case, I also focus on fat fixation, with the aim of maintaining the fat in the planned position and minimizing unnecessary displacement or spreading.

Fat grafting around the eyes requires a high level of precision because the area contains important anatomical structures and has limited space for volume placement. The amount of fat, exact location, and appropriate tissue plane must all be carefully considered.

My goal is not simply to make the eyes look “less hollow.” I want to restore volume in a way that is harmonious with the patient's facial anatomy while preserving a natural appearance.


What Is the Recovery Like After Upper Eyelid Fat Grafting?

After the procedure, patients may experience swelling, bruising, or a feeling of tightness around the eyelids and the donor area. These are common responses during the early healing period.

During recovery, patients should follow their surgeon's instructions carefully. General recommendations may include:

Avoid rubbing or applying pressure to the eyes
Avoid applying either cold or warm compresses unless specifically advised by your doctor
Avoid activities that may cause impact or trauma around the eyes
Sleep with the head elevated during the early recovery period if recommended
Take prescribed medications as directed
Attend scheduled follow-up appointments
Swelling and bruising gradually improve during the healing process. It is important not to judge the final result too early, because the appearance during the initial period is influenced by postoperative swelling as well as the gradual changes that occur in the transferred fat.


Advantages of Upper Eyelid Fat Grafting
One of the main advantages of fat grafting is that it uses the patient's own tissue to restore volume in areas that have become hollow or sunken.

When a portion of the transferred fat survives and becomes integrated with the surrounding tissue, the result can be long-lasting. However, it is not possible to guarantee that all of the transferred fat will survive. The amount of retained volume varies from patient to patient.

Another advantage is that fat can be placed selectively according to the patient's individual anatomy, making it possible to address specific areas of volume deficiency rather than simply adding volume throughout the entire upper eyelid.


Risks and Important Considerations
Although fat grafting uses the patient's own tissue, it is not a risk-free procedure.

During the early recovery period, swelling, bruising, and temporary asymmetry may occur. Because fat survival can vary between sides and between individuals, some patients may experience uneven volume, contour irregularities, or residual asymmetry. In some cases, additional treatment or revision may be necessary.

One particularly important consideration with fat injection around the eyes is the potential for vascular complications if fat enters a blood vessel. Although this is uncommon, complications involving the vessels around the eye can be serious and, in rare cases, may affect vision.

For this reason, upper eyelid fat grafting should be performed by a surgeon with appropriate expertise in oculoplastic surgery and periocular anatomy, with careful preoperative assessment and a technique selected specifically for each patient.

If you experience unusual symptoms after the procedure, such as severe or increasing pain, rapidly worsening swelling, or any change in vision, you should contact your surgeon or seek medical evaluation promptly.


What I Want My Patients to Understand Before Choosing Fat Grafting.
For me, treating hollow upper eyelids is not about adding as much fat as possible.

It is about understanding the patient's anatomy and restoring the appropriate amount of volume in the right location.

The eyes are one of the most delicate areas of the face, and even a small change in volume or position can significantly affect the overall appearance. Too much fat can make the eyelids look puffy or heavy, while too little may not adequately address the hollow appearance.

That is why every patient should first be evaluated to determine why the eyes look hollow and which treatment is most appropriate for the underlying cause.


Conclusion
Upper Eyelid Fat Grafting is one option for patients with hollow or sunken upper eyelids caused by volume deficiency. By using the patient's own fat, volume can be restored selectively to areas that require correction.

However, successful treatment involves much more than simply injecting fat. Careful assessment of the periocular anatomy, appropriate donor-site selection, fat preparation, precise placement, and fixation of the fat all play important roles in achieving a balanced result.

If you are considering treatment for hollow upper eyelids, I recommend having an individual assessment first. This allows us to determine the underlying cause of the hollow appearance and whether fat grafting is the right option for you.

Because when it comes to the eyes, the goal is not simply to make them look fuller.

The goal is to restore a fresh, balanced, and naturally harmonious appearance.

Dr. Penake Thongtong
Oculoplastic Surgeon
D Bangkok Clinic