Why do people get bags under their eyes as they age?
Plastic surgeons have long attributed the problem to the "herniation" of the membrane that holds fat in the orbital socket, which supposedly weakens with age and allows fat to slip out.
However, a plastic surgeon in Los Angeles has found a different cause for those bags, which he politely refers to as "lower eyelid prominence."
It turns out that as we age, we tend to accumulate more fat in that area, which can be removed only by cosmetic surgery.
"What happens is that the orbital fat surrounding the eyeball increases with age and then pushes the lower eyelid forward," says Dr. Sean Darcy of the David Geffen School of Medicine at UCLA and a plastic surgery resident at the University of California in Irvine. "The fat has nowhere else to go."
Darcy's study, published in the Journal of Plastic and Reconstructive Surgery, used magnetic resonance imaging, known as an MRI, to study 40 subjects between the ages of 12 and 90 to determine what happens to the lower eyelid with age. The results could have a large impact on the practice of blepharoplasty, the surgical rejuvenation of upper or lower eyelids, which was performed on 241,000 Americans in 2007, according to the American Society of Plastic Surgeons.
Until now, plastic surgeons thought that tightening slack muscles in the lower eyelids would reverse the puffiness that makes them look baggy.
"Our study is the only one to measure what actually happens to the tissue with age," Darcy says. "Just taking the fat out relieves the anatomical problem. It's a more conservative approach."
If fat makes the lower eyelids puffy, wouldn't losing weight help?
Apparently not. Autopsies on people who died of starvation show that they have the same amount of orbital fat as people of normal weight.
"For some reason orbital fat is different," Darcy says. "You need that orbital fat to keep the eye lubricated and to provide support for the eyeball in the bony orbit. It makes sense that the body maintains the fat there even when the fat from the rest of the body is gone. That's why you only want to remove the fat that increases with age. If you keep going you'll disrupt the muscles in the bony orbit."
Can anything be done short of cosmetic surgery to reduce the size of bags under the eyes?
According to Darcy, some people use the hemorrhoid treatment Preparation H on their eyelids.
"It's a vasoconstrictor," he says, "and it does help some people in terms of relieving some of the edema or fluid accumulation around the eyelid. A lot of actresses use that to minimize the tired look they get overnight. In Southern California you hear about remedies like that."
Freelance writer Tom Valeo writes about medical and health issues. Write to him in care of the St. Petersburg Times, P.O. Box 1121, St. Petersburg, FL 33731, or e-mail firstname.lastname@example.org.