One of the earliest and most recognizable signs of facial aging is what occurs around the eyes. Because of the constant movement of the eyelids, the sphincteric action of the surrounding muscle units, and the thinness of the eyelid skin, the effects of time (and sun exposure and lack of a good skin maintenance program) first become noticeable in this area. These aging effects are recognized as lines, wrinkles, and bags.
Wrinkling of the skin is easy to understand because it occurs all over the face. It is the eye bags that are harder to figure out why they are there. Everyone knows eye bags occur in many people but why they are there is more of a mystery to the general public. I know it is a mystery because of all the eye creams and potions that are marketed to improve it. Once one understands the cause of eye bags, it is easy to appreciate why they are impossible to eliminate with any cream.
The development of fullness under the lower eyelids is the result of fat that was originally under the eyeball. Our eyeball is encased in a surrounding sea of fat and muscle. The fat serves as a natural cushion to protect it from outer compressive forces. It allows the eyeball to be moved around without risk of injury. The fat under the eye is naturally held back by a thin film of tissue that runs between the lower eyelid (tarsus) and the rim of the lower eye socket. With age this tissue weakens, allowing the fat it constrains to protrude out. In some ways, it is like a hernia which is why it is referred to as lower eyelid fat herniation.
Since fat is largely composed of water, it can get bigger or smaller based on one’s water content. Eyebags are well known to be bigger in the morning (being horizontal all night) or if one has eaten a lot of salty foods the night before. (water retention) The size of a lower eyebag can be slightly improved by cold compresses (or cut pieces of cucumber) and some type of topical astringents. But no type of cream can get rid of the protruding fat in any significant amount.
Eyebag removal can be done through two types of eyelid (blepharoplasty) techniques. If there is a lot of extra lower eyelid skin, then a more traditional open bkepharoplasty is done. By making a fine incision just beneath the eyelashes, the skin can be lifted away from the eyelid, the protruding fat removed, and the extra skin removed as the eyelid incision is closed. Most men and women over age 50 need this type of eyelid surgery to make a real difference.
If one is younger and excess skin is but a minor issue, an internal approach can be used. By going through the inside of the eyelid (no incision on the outside), the protruding fat is removed through this scarless route. The little bit of extra skin can then be safely tightened through a medium-depth chemical peel on the lower eyelid.
‘Debagging’ the aging lower eyelids is an important part of making the eye area look better for many patients. How much skin you have determines whether the incision to remove the fat is done from the inside or the outside.
Dr. Barry Eppley
Indianapolis, Indiana