Eyelid depressions, commonly referred to as sunken eye sockets, are very aesthetically pleasing. Causes and classification of eyelid depressions Eyelid depressions can be classified as congenital or acquired. Congenital eyelid sunkenness is caused by a decrease in collagen or elastic fibers and subcutaneous tissue due to aging. It can also occur in the presence of ptosis or unilateral lids with weak levator muscle function. Acquired eyelid depressions are caused by excessive removal of orbital fat or orbicularis muscle during blepharoplasty, which can lead to triple vision. Treatment of eyelid depressions Treatment of eyelid depressions varies depending on the cause, from tissue redistribution to correcting the depression to using new tissue fill. Tissue redistribution is the loosening of adhesions at the site of the depression and redistribution of other tissues such as orbital fat to correct the eyelid depression. Tissue filling is a method of transplanting your own tissue to the eyelid. 1. Tissue grafting The most commonly used self-tissue for tissue filling is: dermal fat grafting or free fat grafting. In contrast to dermal fat grafting, the former does not predict the absorption rate of the grafted tissue, so it is difficult to determine the exact amount of filler. In the case of dermal fat grafting, a satisfactory cavity is formed under the orbicularis oculi muscle and a sufficient amount of dermal fat tissue is placed. 2. Tissue redistribution Eyelid depression is one of the complications of blepharoplasty and is caused by excessive skin separation, excessive removal of the orbicularis or orbital fat and damage to the orbital septum, which requires excision of the scar, loosening of the adhesions and redistribution of the tissue for correction. The sunken upper lid deformity is corrected by realigning the eyelid tissue distribution through blepharoplasty.