LAM FACIAL PLASTICS

Hi Dr. Lam,

I have one eyelid crease that is a bit higher than the other due to surgical removal of a suture granuloma. I had some orbital fat repositioning to correct that, but now the crease and orbit look higher and more hollow than that of the other eyelid because of the removal and repositioning of orbital fat.

I have contemplated either pearl fat grafting into the eyelid, fat injections, or Juvaderm/Restylane. I'd like to do the one which will last the longest; I think any of the above will correct it visually. I have heard that fat only lasts some of the time, depending on the person. Others have said their Juvaderm/Restylane injections into the upper eyelids retained bulk due to formation of scar tissue, or whatever, and became permanent. Have you ever seen this happen?

Can you give me your feelings on which procedure(s) you like or don't like for the upper eyelid only, in the crease area. Thank you!

Sapphire

good questions. here are my thoughts:
1. i don't use a lot of Restylane in the upper eyelid and brow a lot since I tend to focus on the central and lower face to inject it. I can't speak of permanence or longevity.
2. as far as fat, it works well in the face but in the brow area i have had some variable results. i agree. also, i hate using fat just to fix a little problem for two reasons. i like using fat to balance the whole face evenly, which leads me to the second point. i am not a big fan for putting fat asymmetrically to fix asymmetry since over time when the fat gets its blood supply it may grow a bit asymmetrically. it is simply harder to predict.

i would probably say, try out the restylane first since it is a lot less expensive and focused on a small problem that you see and is probably better than fat given the limitations i have presented in 2.
best,
sml

Thank you - that sounds reasonable. Fat injections are much more expensive for a small area.

no problem.
best,
sml