Eye Hollow Filler: Why I Fill Sunken Lids in Two Sessions

I'm Dr. Jong Seon Kim, a director at Gangnam HERA in Seoul. I'm a full member of the Korean Society of Oculoplastic Surgery and a board member of the Korean Society of Aesthetic Surgery, and the eye area is where I spend a great deal of my clinical time. In this video I talk about a filler I am personally very fond of: eye-hollow filler, sometimes called upper eyelid filler. It can be tricky without experience, but when the right amount goes in the right place, it can refresh a tired-looking eye in one visit.

My short answer: upper eyelid filler fills the sunken hollow between the brow and the eyelid crease. I use hyaluronic acid filler with a very fine cannula, split the treatment into two sessions about three weeks apart, and explain beforehand that the double-eyelid fold will usually look a little smaller.

What is an eye hollow, and why does the upper eyelid sink?

An eye hollow is a sunken upper eyelid between the brow and the lid edge, and in most people it is simply inborn. The hollow makes the eyes look tired, and it can make a double eyelid look as if it has two or three layers. The causes I see are:

• Your natural anatomy — by far the most common reason.
• Aging, as fat around the eye gradually decreases.
• Previous double-eyelid surgery where a lot of fat was removed.
• Rapid weight loss — I occasionally see patients whose lids hollowed after a strict diet.

Why filler instead of fat grafting for eye hollows?

Because filler can be dissolved if the result is not what you wanted — and that is its biggest advantage. Early in my career I treated eye hollows mostly with fat grafting. Now I mostly use filler, for a few reasons:

• Fat grafting is a bigger procedure. Fat has to be harvested, which usually means sedation and more preparation.
• Fat survival is unpredictable. We usually expect about half of the grafted fat to survive, but it is not exactly half; it varies by person and area, so there can be too much left or too little.
• Fat is less smooth. Its particles are coarser than filler, so in some cases a slight unevenness can appear.

Filler can also look uneven if it is not handled delicately, so technique still matters. But if a filler result is not right, it can be dissolved with hyaluronidase. My colleague Dr. Jong Hoon Lee recommends fat grafting in some under-eye cases where the skin is very thin — that is a different area and a different problem, which he explains in his video on dark circles. I compare the two options for the upper lid in more detail in sunken eyes: filler vs fat transfer.

How long does upper eyelid filler last?

In my experience, once settled, usually about 1 to 1.5 years — and sometimes 2–3 years. Duration differs by area and varies enormously from person to person, so I give this as a range I see in practice, not a promise.

Does eyelid filler hurt, swell or bruise?

Usually much less than people fear. I apply numbing cream to the lid for a short time, then treat with a very fine cannula. The upper eyelid is less sensitive than people expect. Patients are sometimes frightened simply because it is near the eye, but it is very rare for anyone to be unable to continue because of pain. Because the amount used is small, swelling is usually minimal and bruising is uncommon. As with any filler, redness, swelling, bruising and rarer complications are possible, and results vary.

Why do I treat the eyelid in two sessions?

Because hyaluronic acid attracts water, and I need to see how your lid behaves before I finish. I think of the areas above and below the eye as two-step treatments: a first fill, then a finishing session about three weeks later.

Some people swell a lot in the morning. In them, not only the tissue around the eye but the filler itself can take on water, so it acts like a slightly larger amount than was injected. On a puffy morning the lid can feel heavy or look lumpy. Splitting the treatment lets me check whether you are prone to swelling and adjust the second step accordingly. It is one more way of not overshooting — the same principle I explain in why less filler looks better.

For international patients this means planning two visits about three weeks apart. If you can only make one trip, tell us in advance and we will discuss a more conservative single-session plan.

Will eyelid filler change my double eyelid?

Yes — the fold usually looks slightly smaller, and I always explain this before treatment. As the lid sinks, the double eyelid looks larger; if it sinks a lot, the fold can even flatten out. When the hollow is filled, the fold becomes a little lower. For most patients that is part of the refreshed look, but if you love a high fold, we discuss it first.

What should international patients know before eyelid filler?

Plan for two sessions, a written estimate and a short recovery.

1. Assessment. I check whether the hollow is fat loss, anatomy, a previous surgery effect, or something filler cannot fix, such as a weak eyelid-opening muscle.
2. An itemized written estimate that names the product and amount. International patients pay the same as local patients, and an English interpreter is with you.
3. First session with numbing cream and a fine cannula.
4. Second session about three weeks later to finish.

For more on who suits this kind of filler and where it stops, read dermal fillers for sunken eyes; for cost factors, what sets the price of eye filler in Korea.

The honest limits

Eye-hollow filler is not easy for an inexperienced injector, and it is not right for every eyelid. It fills a hollow; it does not lift a drooping lid or correct a weak eyelid muscle, and too much filler here looks heavy faster than almost anywhere else. When it is done well, though, it is one of the most rewarding fillers I do. If you want to check a doctor's experience first, the signs to check in a Korea filler expert is a good place to start, and you can see real HERA results in our before-and-after gallery.