Objective <p>This study aimed to perform a retrospective analysis of clinical data from 94 patients with sunken upper eyelid, investigating the etiologies, types, and surgical approaches for this condition, so as to provide a theoretical basis for the clinical prevention and treatment of sunken upper eyelid.</p> Methods <p>Clinical data of 94 patients who underwent sunken upper eyelid correction in our hospital from June 2024 to May 2025 were retrospectively summarized and analyzed. The collected data included general patient information (age and gender), history of previous upper eyelid surgery, presence of comorbidities (e.g., multiple eyelids, wide double eyelids, and blepharoptosis), as well as the surgical method employed, surgical outcomes, and occurrence of surgical complications. All patients were followed up for 6–9 months postoperatively. Patient satisfaction was evaluated based on indicators such as bilateral upper eyelid morphology, fullness, and symmetry.</p> Results <p>Among the 94 included patients with sunken upper eyelid, there were 84 females and 10 males, with a mean age of 34 years. According to the presence of a previous upper eyelid surgery history, the patients were categorized into two groups: 16 cases (17.0%) of primary sunken upper eyelid (without a history of upper eyelid surgery) and 78 cases (83.0%) of secondary sunken upper eyelid (with a history of upper eyelid surgery). Analysis of surgical records showed that 12 patients underwent autologous granular fat injection transplantation, while 82 patients received open surgical correction for sunken upper eyelid. The causes of sunken upper eyelid in this study mainly included two types: absolute deficiency of orbital septal fat content (58 cases, 70.7%) and relative deficiency of orbital septal fat content (24 cases, 29.3%). The mean preoperative depth of sunken upper eyelid was 8.2&#xa0;mm, and this value significantly decreased to 2.7&#xa0;mm at the last postoperative follow-up (<i>p </i>&lt; 0.05). The mean Global Aesthetic Improvement Scale score at the last follow-up was 2.34.</p> Conclusion <p>Clinically, sunken upper eyelid is mostly caused by excessive removal of orbital septal fat during previous upper blepharoplasty. A comprehensive repair strategy is recommended, which prioritizes the restoration of orbital septal fat volume via orbital septal fat release or transposition and flake fat grafting, supplemented by autologous granular fat injection transplantation. For patients with comorbidities such as multiple eyelids, wide double eyelids, or blepharoptosis, simultaneous correction of these comorbidities while addressing the sunken upper eyelid is advisable to achieve optimal clinical outcomes.</p> Level of Evidence IV <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>