Similarly, patients who have undergone aggressive upper or lower blepharoplasty with removal of excessive fat and muscle may recognize either immediately or gradually that their lower eyelids have grown more vacant and their upper eyelid creases are rising higher and deeper.
In the past, such changes have been referred to in the medical literature as a "skeletonized eye" or the "sunken socket syndrome." Dr. Meronk has proposed two newer designations:
When lower hollowness follows over-resection of orbital fat during blepharoplasty, we have dubbed the resulting anatomical cascade of changes the "orbital flat tire."
For advanced hollowness in the upper orbit caused by both orbital and sub-brow fat loss, we have proposed the term "doll's eye deformity" to better describe its effect on eyelid appearance.
Since some lower eyelid fullness and a relatively low upper eyelid crease are signs of youth, noticeable orbital hollowness make the face look older and more tired. When hollowness is advanced, it may be associated with inward collapse of the eyelid that produces a variety of eye and eyelid positional abnormalities.
Even though patients with hollowed eyes after blepharoplasty are among the most unhappy in all of plastic surgery, previous corrective operations have proven largely unsuccessful.
