Many patients notice changes in their lower eyelids that result in an "aged" or "tired" appearance. There are several reasons that patients develop these changes. Some patients have what is called fat pseudo-herniation, which is a condition where orbit and eyelid fat starts to come forward and become more visible in the under-eye region.
When we are younger, this fat is typically held back by a membrane known as the septum. As we age, that septum becomes loose--like a hammock--allowing the fat to come forward and give the appearance of "bags" in the lower eyelid.
Directly below these "bags" is a ligament called the orbicularis retaining ligament or ORL. This ligament causes a "valley" between the lower eyelid and the cheek, thereby worsening the appearance of the lower eyelid bags. This ligament becomes more obvious as we age due to changes in the bone and soft tissues in the cheeks.
The patient below had a surgery called transposition lower eyelid blepharoplasty. In this surgery, the ligament that causes the "valley" is elevated and the fat that forms the "bags" in the lower eyelid is moved down into the the valley. The has the effect of softening the transition between the eyelid and the cheek and makes for a less "tired" and more youthful appearance.
This schematic shows how the surgery is done. The ligament is lifted and the fat is moved from the lower eyelid bag into the cheek and held into place with soft sutures for 3-5 days. In this way, the "valley" under the eye is filled with the "bag."
Dr. Vrcek is happy to offer transposition lower eyelid blepharoplasty to his patients. He is one of only a few surgeons in the Dallas area trained in this advanced type of blepharoplasty. Fortunately, this technique often can be done without large skin incisions. Instead, the fat is accessed through the inside portion of the eyelid. This allows for less downtime and significantly decreases post operative bruising and swelling.
Not every patient needs surgery to treat lower eyelid bags--every situation is different. Some patients can do well will fillers like Restylane. Check back soon for a post about lower eyelid fillers!