Bilateral Eyelid Pseudoptosis From Lipogranulomas of the Preaponeurotic Fat Pads

A 49-year-old Cambodian woman developed bilateral eyelid pseudoptosis due to lipogranulomas in the preaponeurotic fat pads, likely from surreptitious silicone injections despite her denial of any prior injections. Histopathological examination revealed vesiculations surrounded by collagenous lamina and histiocytes, characteristic of silicone granulomas. Surgical excision of the abnormal fat pads restored normal eyelid function and appearance, with no recurrence over 18 months. This case underscored the importance of considering silicone injections in the differential diagnosis of similar presentations and highlighted the unique histopathologic features of lipogranulomas.