The appearance of under eye bags is one of the most frequent complains that I see in my practice in Morristown New Jersey. This problem is du to under development of the maxillary bone causing the lower rim of the orbit to be lower and farther back making the lower lid appear longer in the vertical direction. With the aging process and laxity of the tissues the orbital fat which normally surrounds the eyeball pushes through the weakened tissues and shows a bulges that we call bags. The dark circle under the lower lids is the soft tissue attachment to the bonny orbit which creates a depression. The bulging tissue above adds insult to injury and creates a dark shadow making the circles look even worse. the patient looks tired and no make up can help. The only product that could make a little difference temporarily is an albumin serum that shrinks the skin as it dries up and will give a little improvement until it is washed off. The treatment can be both surgical or non surgical.
1) Non Surgical Treatment of the Lower Eyelid Bags: The non surgical treatment is filling the dark circle depression with Restylane. This works when the bags aren’t too big. By filling the depression between the bag and the cheek one can blend the eyelid to the cheek and improve the appearance. In my opinion there is only one way to do this safely and that is with a blunt needle to avoid injecting in a blood vessel. it also hurts less and doesn’t bruise.
2) Surgical Treatment of the Lower Eyelid Bags: The surgical treatment has changed over the years. Initially it was though that by removing all the eyelid excess fat this condition could be corrected. This treatment has left many people with hollow eyes which is treating one deformity with another. Small amounts of fat and skin could be removed if the problem is mostly the fat and not a bony deficit. If the skin is not too redundant, the fat could be removed through inside of the lid by doing the so called transconjuctival approach.The current techniques tend to preserve most of the fat and move it down into the grove that makes the dark circles, blending the lid-cheek junction. Supporting the lower lid with a lateral canthopexy or with a muscle suspension to the side of the orbit is definitely necessary. This kind surgical treatment demands a lot of experience, understanding and talent so be careful who you go to.