INTRODUCTION
Supraorbital hollowness is a feature that gives an unesthetic, aged, and cadaveric aspect to the eyelids, giving the impression of fatigue even if the person is well rested (Figure 1).1 This deformity may be referred to as an A-frame deformity, superior sulcus syndrome, upper eyelid hollowing, sunken superior sulcus, or sunken upper eyelid (SUE).1-2 We consider this last definition the most appropriate term to describe this condition, and SUE has therefore been used throughout this paper.
There are several changes induced by aging in the upper eyelid.1-3 Atrophy of the orbital fat is one of the most noticeable features of aging.1-3 The skin manifests dermatochalasis, or laxity, due to elastosis and thinning, and the lacrimal glands can become ptotic.4 This ptosis is called senile ptosis and appears frequently together with the skin softening, dynamic wrinkles, and hyperpigmentation of the skin resulting from solar exposure.5 The width and length of the orbital fissure change over time, and both the vertical palpebral and the horizontal palpebral fissures decrease gradually.6 Age-related bone resorption of the orbits is most significant in the inferolateral and superiomedial sides, essentially contributing to the palpebromalar groove and the SUE respectively.26 All these changes may occur earlier in patients with high radix and pronounced frontal bone.7
Since SUE is frequently the first sign of aging noted by a patient and one of the first areas capturing people’s attention, the desire to rejuvenate the aging SUE is constantly increasing.6-8 Replacing lost volume may provide the treated patient with less evidence of aging, thus essentially giving them a powerful
There are several changes induced by aging in the upper eyelid.1-3 Atrophy of the orbital fat is one of the most noticeable features of aging.1-3 The skin manifests dermatochalasis, or laxity, due to elastosis and thinning, and the lacrimal glands can become ptotic.4 This ptosis is called senile ptosis and appears frequently together with the skin softening, dynamic wrinkles, and hyperpigmentation of the skin resulting from solar exposure.5 The width and length of the orbital fissure change over time, and both the vertical palpebral and the horizontal palpebral fissures decrease gradually.6 Age-related bone resorption of the orbits is most significant in the inferolateral and superiomedial sides, essentially contributing to the palpebromalar groove and the SUE respectively.26 All these changes may occur earlier in patients with high radix and pronounced frontal bone.7
Since SUE is frequently the first sign of aging noted by a patient and one of the first areas capturing people’s attention, the desire to rejuvenate the aging SUE is constantly increasing.6-8 Replacing lost volume may provide the treated patient with less evidence of aging, thus essentially giving them a powerful
