Aging results in changes in the appearance of the lower eyelids. Due to loosening of the supporting layers of the eyelid, the fatty tissue that normally surrounds the eye begins to bulge, producing bags under the eyes. “Bags” beneath the eyes normally develop with age but sometimes are seen in young adults. When seen in young adults this tends to be a familial trait.
Lower eyelid surgery is designed to improve the appearance of these imperfections. This procedure can restore a youthful shape to the lower eyelid by either removing the protruding fat or tightening the loosened eyelid layer that holds the fat.
Another characteristic of an aging lower eyelid is a deepening of the fold that sits between these “bags” and the cheek. This area is called the “tear trough” and tends to emphasize lower eyelid “bags”. It also accentuates the dark circles beneath the eyes. As this groove develops, it lengthens the distance between the eyelashes and the cheek causing the lower eyelid to seem long, while youthful lower eyelids appear short.
In an attempt to add volume to the “tear trough”, some of the same fat that is often removed during this procedure can be repositioned to fill the “tear trough”. A non-surgical option to improve the appearance of the lower lid is to fill the area of depression with filler agents. This is appropriate for those patients who have minimal “bags” but deeper “tear troughs”. We have been pleasantly surprised that the lifespan of the filler material when used for this purpose can be measured in years rather than the usual months.