Lower Eyelid Bags

For the first time, I’ve noticed lower eyelid bags. What causes them and how do I get rid of them?

Before we talk specifically about lower eyelid bags, it may help to start with a broad overview of facial aging. Our knowledge of facial aging continues to grow; we now know several different factors contribute to facial aging. These factors include changes in our skin, changes in the soft tissues beneath our skin and changes in the deep foundation of our faces – our facial bones.

Our skin is constantly exposed to the sun, leading to numerous changes. The sun can rob our skin of its youthful glow and put us at risk for skin cancers, but changes in our skin alone doesn’t tell the whole story.

In addition to changes in our skin, the soft tissues beneath our skin evolve with time. Our faces have several layers of soft tissue - facial fat plays a key role role in several of these layers. As we age, our facial fat deflates and the youthful fullness of our faces fades. Facial fat and facial volume are both critically important to a youthful look - some experts feel volume loss is the most important change seen as our faces age.

While our facial soft tissues lose volume, our facial foundation changes too. The bones of the face change throughout our lives. These bones can actually “shrink” in certain areas, such as the area beneath the eye socket.

Taken together, changes in structures of the face contribute to lower eyelid bags. A youthful face has a smooth transition from the eyelid to the cheek, but as we age we lose that smooth transition. Instead, we often develop a valley between the eyelid and the cheek, which shows up as lower eyelid “bags.” This valley is sometimes referred to as the “tear trough.”

What are the treatment options?

The most commonly recommended option is surgery, known as a lower eyelid blepharoplasty. See our overview of lower eyelid blepharoplasty to learn more.

Are there any alternatives?

Yes. A quick internet search will reveal that there are non-surgical options. Perhaps the most popular nonsurgical option includes facial fillers such as Belotero® and Restylane®. Fillers are products that add volume to the face. The idea of adding more volume to the face may seem strange when you are bothered by “bags” – given “bags” seem like extra tissue. If you have “extra” tissue, why add more? Yet fillers can be very effective for lower eyelid bags.

Beneath the lower eyelid bag, the valley known as the “tear trough” separates the lower eyelid from the cheek. Adding volume into this valley can smooth the transition between the cheek and lower eyelid. This can lead to a dramatic transformation.

Although facial fillers are commonly used in in this area, they have not been specifically studied by the FDA for their use in this area, so their use here is considered “off label.”