Lower Eyelid Bag Correction

Matthew C Camp, MD
Board Certified Plastic Surgeon

The periorbital region, including the lower eyelid, undergoes significant anatomical changes with age, leading to the development of perceived bags under the eyes and a haggard appearance. These changes are multifactorial and involve both intrinsic and extrinsic factors.


One key factor contributing to the development of lower eyelid bags is the thinning of facial skin and the adherence of the skin to the lower orbital rim. As individuals age, there is a gradual loss of collagen and elastin fibers in the skin, leading to decreased skin thickness and elasticity. This thinning of the skin allows the underlying orbital fat pads to become more prominent, resulting in the appearance of bags under the eyes.


Additionally, there is a loss of volume in the region of the palpebromalar junction, which refers to the area where the lower eyelid meets the cheek. This loss of volume further exacerbates the appearance of lower eyelid bags and contributes to the haggard appearance commonly associated with aging.


Recent advancements in imaging technology, such as 3D imaging, have allowed for the precise mapping of these anatomical changes in the periorbital region. This has facilitated a better understanding of the underlying mechanisms contributing to the development of lower eyelid bags.


A novel approach to addressing this cosmetic concern is the administration of subcutaneous fat to the affected area. This minimally invasive treatment involves harvesting fat from a donor site, such as the abdomen or thighs, and injecting it into the periorbital region to restore lost volume and reduce the appearance of lower eyelid bags by blending the transition from the eyelid to the cheek.


Compared to traditional treatments using hyaluronic acid fillers, the use of autologous fat has several advantages. Fat grafting provides a longer-lasting result due to the presence of viable adipocytes that can integrate with surrounding tissues. Additionally, fat grafting is associated with a lower risk of complications and allergic reactions, as the fat is derived from the patient’s own body.