They do come in complaining of a couple of things for which one of the treatments is fat and the commonest thing is bags of the lower lid and what’s called the tear trough where you get a hollowing there and the surgeon then has to analyze the situation to give a logical treatment because it’s not like if there is a hollow, you fill it with fat because there is a hollow because of aging and aging has more to do with the bone than it is to be with the soft tissue. This is a bit unexpected for people to hear this because I don’t just talked about the bone, because I don’t treat the bone. I only talk about what they want to treat.

But the fact is that when people get into their ‘20s, the bone of the inner cheek in particular starts to shrink and you can imagine if the cheek bone shrinks, the soft tissues go back and as they go back, they drop down a bit and that’s why the bags start to show. So the easiest thing to do is to treat the bag and take out the fat. And sometimes it’s the right thing to do, but the most logical thing to do is to treat the deficiency of bone because then you corrected the cause of the problem so you’re going to revert back to one natural appearance and when you treat the bone by building an outward coral [SP], the coral actually turns into the bone. The patient’s bone grows in, so you got a permanent correction of an area that’s so important.

The lower lid is really important because when we look at each other, it’s all eye contact, whether you’re looking across the road with a stranger. My little dog at home looks straight into my eyes, so it’s really fundamental and power. Little babies look straight into their mother’s eyes. So the lower lid is really important because when we look straight ahead, we just pick up inferences of what’s around. If the lower lid is aging, we picked that up and therefore we immediately associate unconsciously that that person is tired and aging. So a small correction at an early age is the right thing to do and offer early intervention.

Under Eye Bags and Hollows May Require Bone Treatment

Dr. Bryan Mendelson explains that while injections of fat and fillers into the face may help to soften a person's appearance, often times an older patient may actually need treatment of a shrinking cheek bone.