Correction of sunken upper eyelids using the triple plane technique with hyaluronic acid fillers

Background: Sunken upper eyelids, characterized by volume deficiency, cause aesthetic and functional issues, such as an aged appearance and ocular discomfort.Objective: This study aimed to evaluate the effectiveness and safety of the triple plane technique using hyaluronic acid (HA) fillers tailored for three anatomical layers (retro-orbicularis oculi fat [ROOF], supraorbital fat, and dermal layer) in correcting sunken upper eyelids. Methods:In this retrospective cohort study, 357 patients treated from January 2021 to June 2024 were classified by severity (grades 1-4).The triple plane technique involved injecting high-viscosity cross-linked HA filler into the deep ROOF layer, mixed cross-linked and non-cross-linked fillers into the intermediate layer, and fine-particle HA filler with polydeoxyribonucleotide into the dermal layer. Results:Outcomes were assessed based on visual improvement in eyelid hollowness.All Grade 1 patients (n=100) achieved complete normalization.In Grade 2 patients (n=140), 23.6% improved by two grades (to normal), and 76.4% improved by one grade.In Grade 3 (n=62), 35.5% improved by two grades and 64.5% by one grade.For Grade 4 (n=55), 21.8% improved by three grades, 18.2% by two grades, and 60.0% by one grade.No severe complications were observed, and patient satisfaction was high. Conclusion:In conclusion, the triple plane technique with HA fillers provided effective, safe, and aesthetically pleasing results across varying severities of sunken upper eyelids.Further research is warranted to evaluate its long-term efficacy and sustainability.