Sunken Eyelid Filler: Restoring the Crease, Softening the Look

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 filler is the main part of my practice. Of all the areas I inject, the sunken upper eyelid — what Koreans call the "eye hole" — is the one I personally enjoy most and take the most pride in. In this video my colleague Dr. Jong Hoon Lee and I reviewed four of our eyelid cases to show why.

My short answer: filling a sunken eyelid is the easy part. The real skill is filling it so the double-eyelid crease underneath comes back smooth — with a soft filler, a small amount and the right layer.

Why does a sunken eyelid change your impression so much?

Because the hollow does not only look tired — it pulls on the skin and distorts the crease. When the area under the brow loses volume, the eyelid skin is drawn upward into the hollow. The original double-eyelid crease can then split into two or three folds, widen too much, or twist. The eyes look older, more tired and sometimes harsher than the person really is.

That is why I call upper-eyelid filler a specialist filler. Most people expect it to be about volume. In practice, the filling is not the hard part. The hard part is making the crease underneath come out clean at the same time.

What happens when a crease splits into two layers?

Often the hollow is the cause, and filling the volume lets the folds settle back into one crease. One patient in the video had her own natural crease, but the hollow above it had added an extra fold on top, so she had a double layer. Here the job was mainly to restore volume.

Compared with an earlier case of ours — a man with very thin eyelid skin, where every bit of volume had to go in exactly the right place — she was a little easier. Her skin had some thickness to it, so simply filling the hollow gave a good result. After treatment her impression looked clearly younger and her eyes more defined.

Can a hollow make the crease look too big?

Yes. When the hollow is concentrated toward the center and inner side, it pulls the crease up there and makes it look larger, while the outer part stays droopy. Our next patient had exactly this: an inner crease that had become too wide and an outer corner that hung lower, with a fairly steep upward slant to her eyes. Together, it gave her a stronger, sharper look than she wanted.

After filling, the right eye came out very smooth. On the left, a small fine line appeared toward the inner corner — I show that honestly in the video. Even so, her overall impression became much softer and gentler, which was what she came for.

Can filler bring back a crease that has almost disappeared?

Sometimes. If a faint original crease is still there under the hollow, filling the hollow can let it reappear. Our last case was a very deep hollow with only a faint line underneath that looked like her old crease. After filling, the crease came back and the result was a happy one.

So these days I treat bringing back the patient's own crease as one of the main goals of the procedure, not a side effect. It is a large part of why the result looks natural rather than "done".

Why is eyelid filler an advanced skill?

Because you have to find the exact point of the hollow, and if the filler sits too thin or too shallow, even the softest product looks lumpy. Dr. Lee said it plainly in the video: I may explain it as if it is easy, but it is not an easy skill. Volume that is in the wrong place does not rise naturally; it just creates an uneven, awkward look.

Before treatment, I also explain what may change. When a hollow is filled, the skin settles downward. A crease that was hard to see may become visible again, and a crease that looked too large may look smaller. For most patients this is the improvement they want, but it is a change in how your eyes look, so we discuss it beforehand.

Why does the upper eyelid need a different filler?

Because the eyelid moves every time you blink, and a firm or heavy filler there can feel uncomfortable. We use filler for volume in the nose, the cheeks and the nasolabial folds, but those areas do not move like an eyelid. On the upper lid I choose a soft, fine-particle filler and place it at a precise level.

When this goes wrong, the problems are predictable: a lumpy surface, discomfort when blinking, or a crease that twists. The way to avoid them is not to be greedy. A small amount, placed delicately, gives a remarkable change with very little downtime, and patients go straight back to their day.

Is filler near the eye dangerous?

There is a danger zone, and the answer is to respect it. Toward the inner part of the eyelid there are blood vessels that lead to the eye. A doctor who understands the anatomy and works carefully in that area can get a safe and good result. This is one area where I would ask any clinic exactly who will inject and how often they treat the upper eyelid — the signs to check in a Korea filler expert lists the questions I would ask.

What does sunken eyelid filler involve at HERA?

An eyelid check, a soft filler in a small amount, and about 30 minutes.

1. Check the eyelid first. I look at the depth and position of the hollow, your skin thickness and your existing crease, and whether the eyelid opens with normal strength. If the real problem is a weak eyelid muscle, filler is not the answer.
2. Plan the crease, not just the volume. I tell you how I expect your crease to change once the hollow is filled.
3. Soft filler, small amounts, the right layer. I add little by little and check your eyes open and closed.
4. Stop early. A slightly under-filled eyelid looks natural; an over-filled one looks swollen.

Numbing cream is used, with local anesthesia if needed. Mild swelling or a small bruise can appear and usually settles within about a week. HERA's domestic hyaluronic acid fillers generally last around 6–12 months and imported ones around 12–18 months. You receive an itemized written estimate before treatment, and an English interpreter is with you. For a broader look at fillers for hollow eyes, dermal fillers for sunken eyes: who they suit and where they stop is a good companion read.

The honest limits

Filler restores volume; it does not create a crease where there has never been one, and it does not fix a weak eyelid muscle. Results are not identical on both sides every time — the small line on one patient's left eyelid in the video is a fair example. HA filler is also temporary, so the hollow returns gradually as it breaks down.

Within those limits, few treatments change a face as much for so little. Restoring a sunken eyelid can turn a tired, harsh look into a soft and clear one in a single short visit. You can see more real results in our before-and-after gallery.