Injectable fillers are the most common form of facial reshaping albeit nonsurgical. The have evolved twenty years ago rom injecting nasolabial folds and lips to being used for virtually any form of facial augmentation effect. Some applications are incredibly common still (e.g., lip and cheeks) and others are becoming commonplace today. (e.g., chin, jaw angles and temples) Since injectable fillers are done on a global basis by a wide range of injector backgrounds and training, the term ‘commonplace’ means you can expect to get it done anywhere that advertises it provides the services.
Infrequent uses for injectable fillers today implies that, while it can be done, not every injector feels comfortable doing so. One such place is the upper eyelid ore more specifically the upper eyelid hollow or supratarsal fold area. This is the upper eyelid region between the upper eyelid crease the and the eyebrow. Its purpose is to decrease a hollow that has occurred from aging (fat loss) or someone who wants a fuller more hooded upper eyelid appearance which is usually younger males.
Placing injectable fillers into the upper eyelid encompasses several basic principles. First only a hyaluron-based injectable filler should be used. A hyaluron-based filler provides a good linear flow to avoid the risk of irregularities or an effect which is not easily reversible. Another useful technique is to avoid needles for injection and use a cannula. This decreases the risk of bruising and provides an ability to lay down a smooth linear line of augmentation. The upper eyelid has a curved shape so I prefer to bend the cannula so the lines of injection can follow more closely this shape. Once can debate whether the injectate should be placed above the orbicularis or below it but most of the time it is a submuscular injection given the firm attachment of the muscle to the very thin eyelid skin.
As seen in this video the curved cannula provides a good line of injection that follows the natural shape of the upper eyelid.
Dr. Barry Eppley
Indianapolis, Indiana