Q: Dr. Eppley, My mother wanted to know if you would recommend anything for her aging eyes, Specifically the hollowness around the upper and lower eyelids.
A: Thank you for sending your mother’s pictures which shows hollowness (loss of volume) on both the upper and lower eyelids. The question is what type of material/graft can be used to add volume to these area. On the upper eyelids it would unequivocally be fat grafts as the upper eyelids have a lot motion so anything applied there needs to be soft. The only debate there is whether it should be done by fat injections or the open placement of a dermal-fat graft. On the lower eyelids options include fat, tissue bank dermis (Alloderm) or implants. Unlike the upper eyelids the lower eyelids don’t move much so they can tolerate grafts or implants. The one requirement they do have is the skin is thin so whatever is placed there must be smooth. For this reason I would favor cut sheets of Alloderm or autologous dermis to lay under the entire lower eyelid and down into the infraorbital-cheek junctions. Many surgeons inject fat into this area but my experience is that often ends up lumpy and puffy looking.
Dr. Barry Eppley