Why do some people with poor orbital bones have tear troughs while others have eye bags?

Question

I have eyebags due to recessed infraorbitals, but many people on the internet with recessed orbitals have no eyebags and instead their lower eyelid skin seems to dip into the face making tear troughs. What causes this?

Jonathan Amspacher, MD · Answer

They eyelid and cheek skin attach to the skin through a variety of different attachment ligaments and septa. The face has multiple fat compartments that help shape the face and these are divided by septal layers. As the face ages many people will get deflation in the upper cheek compartments and bulging of the lower lid as the septum becomes more weak. The difference in individuals is related to a combination of how their facial fat compartments age and how their septa and ligaments sag or stay tight over time.

Why do some people with poor orbital bones have tear troughs while others have eye bags?

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