Eyebags are a very common problem that we see everyday in our Cosmetic Surgery Clinic. Usually the patients will say that they make them look tired whereas they don’t really feel so. Even in certain occupations, such as airline cabin crews, the presence of eyebags is not what their employers are keen of.
To understand how eyebags are formed, we need to relook into the anatomy of the lower eyelid. The lower eyelid consists of a few structures that are closely inter-related to each other. We have the orbital septum, that separates the retro-septal fat from the skin anteriorly. The retroseptal fat is divided further into three separate components, namely the medial, middle and lateral. The medial and middle fatty tissue are separated by the inferior oblique muscle that controls the eyeball movement.
Apart from this very delicate anatomical arrangement, we also have what is known at the tear trough portion of the lower eyelid. This segment is located next to the nasal bridge and the hollowness of tear trough varies between individuals.
As you can see by now, this complex structures make the treatment of any condition here not as straightforward as it may seem.
When tackling the issue of lower eyebags, first I will assess the integrity of the orbital septum, amount of fat protrusion, quality of the overlying skin and depth of the tear trough.
The treatment plan will then be designed specifically based on which deformity that needs to be ironed out, either alone or in combination with one another. For example, if the the problem is due to very deep tear trough, the best option is fillers injection such as hyaluronic acid or fat grafts. On the other hand, if it is due to laxity of the orbital septum, then procedures such as microneedling or Carbon Dioxide LASERs can be utilized. Ultimately, if the issue is due to excessive protrusion of the retroseptal fat, then surgery may be the modality of choice.