Surgical treatment of the sunken upper eyelid.

The youthful upper eyelid shows no depression because the orbital contents are firm and the eyelids are tightly stretched across the bony socket. With progressive aging, there is skeletonization of the orbit as the periorbital tissues undergo laxity or absorption. With aging, hollowing of the eyes results in a deep upper eyelid sulcus. Most surgical procedures that address the aging appearance of the eyes involve excision of excess skin and removal of fat, with resultant volume disproportion that may lead to further hollowing and older appearance. Few procedures have been introduced that address age-related periorbital volume disproportion. We discuss a newly developed surgical technique for the correction of this major orbital aesthetic problem. In this surgical technique, the orbital rim periosteum, periorbita, and released superior extraconal orbital fat are used to fill the superior periorbital space, improving the patient's appearance.