Bags Under Eyes

What Causes Bags Under Eyes?

"Bags under eyes" can occur as we age and the soft tissues over the mid-face and cheek both fall downward as a result of gravity. As this happens, the underlying pockets of fat beneath the globe (eyeball) bulge out from behind a thin overlying membrane called the orbital septum. When this happens lower eyelid tissue becomes more prominent and visible since the previous soft tissue, which used to cover it up, is no longer present. The outward appearance which bothers patients can be barely visible dark circles that appear beneath the eyes to somewhat large loose hanging sacs of excess skin called festoons.

How To Get Rid of Bags Under Eyes

“Bags under eyes” is a cosmetic condition that can be fixed with surgery. In its simplest form (young patient with minimal skin laxity and only dark circles beneath the eyes), a small wedge of skin is removed from the lower eyelid. A portion of the underlying fat beneath the septum is released and "re-draped" up and over the bony prominence beneath the eyeball.

A minimal, if any amount, of the fat beneath the septum is resected. The skin is then sutured along a very fine line just beneath the lower eyelashes. The entire procedure can alternatively be performed via an access incision within the inside surface of the lower eyelid to minimize any external scarring.

In older patients, some portion of this bulging fat is removed. The dissection can be extended further down over the bone to release tissue and perform a "mid-face lift." This maneuver must be accompanied by an additional internal support of the lower lid with various suturing techniques to prevent complications and add longevity to the repair.

In patients with very loose tone to the lower lid, an additional reconstructive procedure called a lateral tarsal strip should be performed. This surgical procedure will protect the repair and prevent postoperative exposure of the cornea. Lastly, patients with extremely loose hanging bags of skin are best served with direct excision of this, which, while very effective, can lead to more visible postoperative scarring.

Bags Under Eyes Consultation

The genetics of a patient play a large role when bags under the eyes may become an issue. Men and women differ as to if and/or when bags under the eyes bother their outward appearance. These procedures are done both in younger and older patients. Please visit the Finesse Plastic Surgery facial procedures gallery under facial procedures, then eyelid surgery, to see some results.

Insurance may cover some procedures to correct bags under the eyes. Specifically, a lateral tarsal strip procedure (referenced above) that is used to tighten the lower lid tone in patients who have developed exposure of the cornea, dryness of the globe and chronic tearing called epiphora.

However, it is important to note this procedure can be performed on its own, without addressing the "fat bulges" on the lower eyelid. Patients can elect to separately pay for the cosmetic repair in addition to what insurance covers in these cases.

Importance of a Board-Certified Surgeon

These procedures can have serious, significant complications if not performed by a qualified, experienced physician. We highly suggest patients do their homework to make sure their surgeon is certified by the American Board of Plastic Surgery.

The title of "cosmetic surgeon" does not signify appropriate training or credentialing – there is no accredited "board of cosmetic surgery."