Eye bags are caused by fat accumulation in three little compartments

Eye bags are caused by fat accumulation in three little compartments in the lower lids and two in the upper lids. This is diet-resistant fat, which means it is not related to weight gain or loss.

Fat pads in the lower lids are removed through an incision on the inside of the lower lids and through an incision along the crease of the upper lids. Fat is not removed with liposuction but by teasing it out and cauterizing it to make sure it does not bleed.

If you have lower eyelid fat bags that bulge significantly out and create a tired look, surgery might be your best bet depending on a careful analysis of your eyelid anatomy and laxity.

The fat can be conservatively removed, it can be shrunk with a cautery device, or it can be transposed down to fill in a tear trough deformity below the bulge. However, lower eyelid surgery in my practice has become relatively rare because so much can be done by adding Restylane into the tear trough to fill in the hollow that creates such a tired appearance.

In fact, in the properly selected patient, the results you can get with Restylane are actually not able to be achieved with surgery. Plus, the lower lids are very sensitive and somewhat prone to complications with surgery, and these are largely avoided with fillers.

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Although this is most often treated with surgery (called a blepharoplasty), no two cases are identical, and for some a nonsurgical option may be worthwhile.

The bags are bulging fat, normally held back in the eye socket. The shadow created along the "tear trough" is what contributes to the problem.

Most surgeons remove the bags by taking out the fat, but as we get older we lose fat around the eyes, and so it may actually accelerate the aging process in the end. Better to reposition the fat into the tear trough rather than remove it in many cases.

For milder cases, a filler into the tear trough such as Restylane, Perlane, or Juvederm often works very well.

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You can remove the bags under your eyes through a lower eyelid blepharoplasty through incisions under or inside your eyes. Skin can also be removed. This is the traditional method of doing this and improving the lower eyelid area. 

You can also fill in the volume deficiency with fillers or some other volume enhancing method. Your lower eyelid has the baggy appearance often from the volume loss that occurs in the cheek area where the loss reveals the infraorbital rim. Replacing this volume can really enhance the appearance in this area with fillers. Fat injections may be the most natural way to improve this area and for a longer lasting effect.

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