Skip to main content

Advertisement

SpringerLink
Log in

Upper Eyelid Filling Approach [U.E.F.A.] Technique: State of the Art After 500 Consecutive Patients

  • Original Article
  • Oculoplastic
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Lately, it has become evident that eye physical aging is mainly due to depletion of the upper eyelid fat causing laxity and wrinkles of the eyelid skin, and new therapeutic strategies aimed at solving the volume loss have appeared in the literature. The aim of this study is to provide a clear classification of upper eyelid aging after 500 consecutive cases and to present a standardization of the therapeutic approach to be adopted when using hyaluronic acid (HA) as fillers or a surgical approach.

Methods

The upper eyelid aging process of a total of 500 patients was classified based on the measurement of the pre-tarsal skin show m and the pre-septal skin show N. A total of 382 patients were treated exclusively with HA injections in the upper eyelid, 45 patients both with blepharoplasty surgery and HA filling, whereas only 73 patients underwent blepharoplasty only.

Results

Patient satisfaction and at least 1-year clinical follow-up were used to evaluate the results. Pre-treatment and post-treatment photographic assessment was considered as well. A total of 447 patients were women, whereas 53 were men. The correct ratio between m and N was restored in all cases.

Conclusions

HA filling can be used as either the only volumization procedure or together with blepharoplasty to restore upper eyelid volume loss. The correct strategy has to be selected on the basis of a clear classification. The upper eyelid filling approach is a safe, manageable, lasting and low-cost technique providing excellent results when the correct procedure is followed.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15

Similar content being viewed by others

References

  1. Korn BS, Kikkawa DO, Hicok KC (2009) Identification and characterization of adult stem cells from human orbital adipose tissue. Ophthal Plast Reconstr Surg 25:27–32

    Article  PubMed  Google Scholar 

  2. Rohrich RJ, Coberly DM, Fagien S, Stuzin JM (2004) Current concept in aesthetic upper blepharoplasty. Plast Reconstr Surg 113:32

    Article  Google Scholar 

  3. Rohrich RJ, Arbique GM, Wong C, Brown S, Pessa JE (2009) The anatomy of suborbicularis fat: implications for periorbital rejuvenation. Plast Reconstr Surg 124(3):946–951

    Article  CAS  PubMed  Google Scholar 

  4. Naik M (2013) Blepharoplasty and periorbital surgical rejuvenation. Indian J Dermatol Venereol Leprol 79:41–51

    Article  PubMed  Google Scholar 

  5. Kruavit A (2009) Asian blepharoplasty: an 18-year experience in 6215 patients. Aesthet Surg J 29(4):263–341

    Article  Google Scholar 

  6. Liew S, Nguyen DQ (2011) Nonsurgical volumetric upper periorbital rejuvenation: a plastic surgeon’s perspective. Aesthet Plast Surg 35:319–325

    Article  Google Scholar 

  7. Trepsat F (2003) Periorbital rejuvenation combining fat grafting and blepharoplasties. Aesthet Plast Surg 27(4):243–253

    Article  Google Scholar 

  8. Lambros V (2007) Observations on periorbital and midface aging. Plast Reconstr Surg 120(5):1367–1376

    Article  CAS  PubMed  Google Scholar 

  9. Lambros V (1998) Fat injection for the aging midface. Oper Tech Plast Reconstr Surg 5(2):129–137

    Article  Google Scholar 

  10. Little JW (2002) Applications of the classic dermal fat graft in primary and secondary facial rejuvenation. Plast Reconstr Surg 109(2):788–804

    Article  PubMed  Google Scholar 

  11. Roberts TL III, Bruner TW, Roberts TL IV (2007) The synergy of multimodal facial rejuvenation: putting it all together. In: Tonnard P, Verpaele A (eds) Short-Scar face lift, operative strategies and techniques, vol II. QMP, St Louis, pp 331–420

    Google Scholar 

  12. Tonnard PL, VerpaeleAM Zeltzer AA (2013) Augmentation blefaroplasty: a review of 500 consecutive patients. Aesthet Surg J 33(3):341–352

    Article  PubMed  Google Scholar 

  13. Lee Y, Kwon S, Hwang K (2001) Correction of sunken and/or multiply folded upper eyelid by fascia-fat graft. Plast Reconstr Surg 107(1):15–19

    Article  CAS  PubMed  Google Scholar 

  14. Park S, Kim B, Shin Y (2011) Correction of superior sulcus deformity with orbital fat anatomic repositioning and fat graft applied to retro-orbicularis oculi fat for Asian eyelids. Aesthet Plast Surg 35:162–170

    Article  Google Scholar 

  15. Gennai A, Zambelli A, Repai E, Quarto R, Baldelli I, Fraternali G, Bernardini FP (2017) Skin rejuvenation and volume enhancement with the micro superficial enhanced fluid fat injection (M-SEFFI) for skin aging of the periocular and perioral regions. Aesthet Surg J 37(1):14–23

    Article  PubMed  Google Scholar 

  16. Coleman SR, Mazzola RF (2009) Fat injection from filling to regeneration. Quality Medical Publishing, St Louis

    Google Scholar 

  17. Bernardini FP, Gennai A, Izzo L et al (2015) Superficial enhanced fluid fat injection (SEFFI) to correct volume defects and skin aging of the face and periocular region. Aesthet Surg J 35(5):504–515

    Article  PubMed  Google Scholar 

  18. Park KH, Kim YK, Woo SJ, Kang SW, Lee WK, Choi KS, KwakHW Yoon IH, Huh K, Kim JW (2014) Iatrogenic occlusion of the ophthalmic artery after cosmetic facial filler injections: a national survey by the Korean Retina Society. JAMA Ophthalmol 132(6):714–723

    Article  PubMed  Google Scholar 

  19. Kim YJ, Choi KS (2013) Bilateral blindness after filler injection. Plast Reconstr Surg 131(2):298–299

    Article  Google Scholar 

  20. Lazzeri D, Agostini T, Figus M, Nardi M, Pantaloni M, Lazzeri S (2012) Blindness following cosmetic injections of the face. Plast Reconstr Surg 129(4):995–1012

    Article  CAS  PubMed  Google Scholar 

  21. Lambros V (2009) Volumizing the brow with hyaluronic acid fillers. Aesthet Surg J 29:174–179

    Article  PubMed  Google Scholar 

  22. Morley AM, Taban M, Malhotra R, Goldberg RA (2009) Use of hyaluronic acid gel for upper eyelid filling and contouring. Ophtal Plast Reconstr Surg 25:440–444

    Article  Google Scholar 

  23. Romeo F (2016) Upper eyelid filling with or without surgical treatment. Aesthet Plast Surg 40(2):223–235

    Article  Google Scholar 

  24. Cox SE, Adigun CG (2011) Complications of injectable fillers and neurotoxins. Dermatol Ther 24(6):524–536

    Article  PubMed  Google Scholar 

  25. Hirsch RJ, Stier M (2008) Complications of soft tissue augmentation. J Drugs Dermatol 7(9):841–845

    PubMed  Google Scholar 

  26. Gladstone HB, Cohen JL (2007) Adverse effects when injecting facial fillers. Semin Cutan Med Surg 26(1):34–39

    Article  CAS  PubMed  Google Scholar 

  27. Glaich AS, Cohen JL, Goldberg LH (2006) Injection necrosis of the glabella: protocol for prevention and treatment after use of dermal fillers. Dermatol Surg 32(2):276–281

    CAS  PubMed  Google Scholar 

  28. Schanz S, Schippert W, Ulmer A, Rassner G, Fierlbeck G (2002) Arterial embolization caused by injection of hyaluronic acid (Restylane). Br J Dermatol 146(5):928–929

    Article  CAS  PubMed  Google Scholar 

  29. Bachmann F, Erdmann R, Hartmann V, Wiest L, Rzany B (2009) The spectrum of adverse reactions after treatment with injectable fillers in the glabellar region: results from the Injectable Filler Safety Study. Dermatol Surg 35(Suppl 2):1629–1634

    Article  CAS  PubMed  Google Scholar 

  30. Leonhardt JM, Lawrence N, Narins RS (2005) Angioedema acute hypersensitivity reaction to injectable hyaluronic acid. Dermatol Surg 31(5):577–579

    Article  CAS  PubMed  Google Scholar 

  31. Moon HS, Ahn B, Lee JH, Rah DK, Park TH (2016) Rejuvenation of the deep superior sulcus in the eyelid. J Cosmet Dermatol 15(4):458–468

    Article  PubMed  Google Scholar 

  32. Liew S, Nguyen DQ (2011) Nonsurgical volumetric upper periorbital rejuvenation: a plastic surgeon’s perspective. Aesthet Plast Surg 35(3):319–325

    Article  Google Scholar 

  33. Jung JM, Choi WS, Jo MS (2014) Correction of the sunken upper eyelid depending on the dermatochalasis or blepharoptosis using the autologous fat grafting. Arch Aesthet PlastSurg 20:148–154

    Article  Google Scholar 

  34. Pessa JE, Rohrich RJ (2012) The eyelids. In: Pessa JE, Rohrich RJ (eds) Facial topography: clinical anatomy of the face, 1st edn. Quality Medical Publishing, St Louis, pp 96–137

    Chapter  Google Scholar 

Download references

Acknowledgments

The author would like to thank Paola D’Angelo for her assistance in the conceptual design, the realization and the revision of the manuscript and for her invaluable help.

Author information

Authors and Affiliations

  1. Studio Romeo, Corso Vittorio Emanuele II n. 18, 00186, Rome, Italy

    Francesco Romeo

Authors
  1. Francesco Romeo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francesco Romeo.

Ethics declarations

Conflict of interest

The author declared no potential conflicts of interest with respect to the research, authorship and publication of this article.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

All patients enrolled in the study provide informed consents.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Romeo, F. Upper Eyelid Filling Approach [U.E.F.A.] Technique: State of the Art After 500 Consecutive Patients. Aesth Plast Surg 43, 663–672 (2019). https://doi.org/10.1007/s00266-018-1296-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-018-1296-6

Keywords

Search

Navigation