Fat causes eye bags, say scientists

Los Angeles: Scientists have come up with the cause of bags underneath the eyes. And the answer is fat.

All is revealed in the September issue of the Journal of Plastic and Reconstructive Surgery.

Reserachers at the University of California Los Angeles used high-resolution magnetic resonance imaging (MRI) to discover that the amount of fat under the eye increases with age.

Lead author Dr Sean Darcy said that cosmetic surgeons commonly believed that it was a stretching of the skin under the eye which caused the problem.

“However, our study showed there is actually an increase in fat with age, and it is more likely that the fat increase causes the baggy eyelids rather than a weakened ligament,” Darcy said. “There have been no studies to show that the orbital septum weakens.”

The study examined 40 subjects (17 males and 23 females) between the ages of 12 and 80. The findings showed that the lower eyelid tissue increased with age and that the largest contributor to this size increase was fat increase.

According to a recent report by the American Society of Plastic Surgeons, nearly 241,000 Americans underwent eyelid surgery in 2007, making it one of the top four surgical cosmetic procedures performed.

Currently, many plastic surgeons performing procedures to treat baggy eyelids do not remove any fat at all. They reposition the fat or conduct more invasive tightening of the muscle that surrounds the eye, or they tighten the actual ligament that holds the eyeball in place. These procedures are performed despite there being no data indicating that these structures change with age.

“Our findings may change the way some plastic surgeons treat baggy eyes,” said study co-author Dr. Timothy Miller, professor and chief of plastic surgery at the Geffen School. “Our study showed that a component of a patient’s blepharoplasty procedure should almost routinely involve fat excision rather than these procedures.”

Blepharoplasty refers to surgical rejuvenation of the upper or lower eyelids, or both, depending on the extent of aging or disease. The procedure is usually performed on the lower eyelid because the most common complaint patients have is that their eyes appear tired, puffy or baggy. The surgeon makes external incisions along the natural skin lines of the eyelid to remove the excess fat and improve the contour of the lower eyelid.

“Although baggy lower eyelids are a significant result of aging and fat expansion, there are other factors that can contribute too,” Miller said. “We recommend that surgeons evaluate each component and address them accordingly in an individualized approach to blepharoplasty.”

The next phase of research will be to perform MRIs of people with baggy eyelids.

The study was supported in part by a UCLA research-enabling grant and a U.S. Public Health Service grant.


Eyelid surgery is known as “upper” or “lower blepharoplasty”. This is one of the most popular cosmetic operations as the skin around the eyes is thinner than on the rest of the face and is usually the first to show signs of ageing. On the upper-eyelid the skin can stetch which can lead to a hooded effect and even – in extreme cases – loss of peripheral vision.

The other problem is bags under the eyes, which are created by an accumulation of fatty tissue underneath, together with a loss of elasticiy in the skin. Some people are affected by both bags and sagging upper eyelids, others by just one or the other. Sometimes bags under the eyes are hereditary rather than a sign of aging, in which case a corrective operation can be performed on someone in their twenties.

The operation:

In the case of the upper lid the excess skin can be trimmed and removed and stitched back in place in what is a reasonably straightforward operation. It can be performed under general or local anaesthetic. Luckily the scar can be created in the crease and is therefore undetectable afterwards. The operation can also be carried out from inside the eyelid. Bags under the eyes can be treated at the same time. With the lower lid, the fat is removed through an incision made close to the lash line and he skin is lifted and stitched back into place. Surgery lasts about one hour and can be done under a local or general anaesthetic.

Stitches are removed from three to five days. The bruising and swelling lasts for seven to 10 days, and the eyes may be watery. The patient’s appearance is back to normal after 15 to 30 days. Eye make-up can be worn by week two, and contact lenses by week three. The scars are minimal, and after two or three months become practically invisible, hidden just beneath the lash lines on lower eyelids and in the natural crease on the upper lids. With lower lids, some surgeons make the incision from inside the lid so there is no visible scarring at all.

These operations are fairly simple, and predictable in their outcome. However, they will not remove the shadows under the eyes, or the crow’s feet wrinkles at the side of the eyes. It will also only remove the wrinkles that are within the skin that is removed. Laser surgery which can be done at the same time can remove other wrinkles. Otherwise a face-lift may be more suitable.

There is no limit to the age at which you can have a blepharoplasty, and many surgeons work on patients in their seventies or older, especially in cases where drooping eyelids leads to problems with vision. Healing is slower in the older patient and could take up to a month.