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

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.

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.

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.

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.

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.