Modifying Upper Eyelid Crease Using Hyaluronic Acid Fillers: A Clinical Case Series.

BACKGROUND: Upper eyelid crease morphology is a critical determinant of periorbital aesthetics. In Asian patients, anatomic variations in levator aponeurosis insertion and preaponeurotic fat distribution frequently result in crease asymmetry or attenuation, particularly in mild-to-moderate cases without true levator dysfunction. Although surgical blepharoplasty remains the standard corrective approach, it is associated with scarring, downtime, and irreversibility.
OBJECTIVE: This study aimed to evaluate the clinical efficacy and safety of hyaluronic acid (HA) filler injections as a nonsurgical technique for upper eyelid crease modification, with particular emphasis on correcting asymmetry and controlling crease thickness.
METHODS: A prospective clinical case series was conducted involving 20 patients presenting with mild to moderate upper eyelid crease asymmetry or thin, attenuated folds. Medium-viscosity HA fillers (Restylane Eyelight, Galderma) were injected into the pretarsal and, when indicated, preaponeurotic planes using a 33-gauge needle. Clinical outcomes were assessed using standardized, blinded photographic evaluation, patient-reported satisfaction scores, and systematic monitoring of adverse events over a 6-month follow-up period.
RESULTS: Improvement in upper eyelid crease symmetry and definition, including perceived crease thickness, was observed in 18 of 20 patients (90%). The mean patient satisfaction score was 4.6 out of 5. Adverse events were mild and transient, consisting mainly of edema (25%) and ecchymosis (15%), all resolving within 1 week. No nodules, vascular occlusion, or vision-threatening complications were observed.
CONCLUSION: Hyaluronic acid (HA) filler injection is a safe, minimally invasive, and reversible technique for refining the upper eyelid crease. Beyond asymmetry correction, this approach allows controlled adjustment of crease thickness, offering a personalized alternative or adjunct to surgical blepharoplasty in carefully selected patients.