Upper Eyelid Droopiness and Lower Eyelid Bags

The periorbital area is one of the first to show signs of aging. We see changes in the bone, soft tissue, and skin. In the youthful female brow, the brow rests above the superior orbital rim or brow bone and has a nice arched contour with the apex generally at the lateral limbus of the eye. It is supported by sub-brow fat. We have nice tone of the frontalis muscle (elevating muscle of the brow) which also helps with the brow position.

In the forehead and brow area, we lose subcutaneous fullness and the intrinsic tone of the glabellar, procerus, and frontalis muscles giving rise to fixed wrinkles and folds. We lose the sub-brow fat pad and see flattening and descent of the brow where we lose the natural contour of the brow we see in youth.

The skin becomes redundant as a consequence of loss of elasticity and collagen. This also adds to textural skin changes such as crepiness of the skin around the eyes. In the upper eyelid we start to see dermatochalasis, or excess skin that is compounded by stretching out of the muscle that lifts the lid, resulting in ptosis or droopiness of the eyelid. We also see descent of the brow that can add a component to this redundancy of skin and may have to be addressed at the same time as blepharoplasty.

The youthful face is characterized by a diffuse and balanced distribution of superficial and deep fat which contributes to volumization of the face and natural youthful convexities. So, we see loss of soft tissue fullness in certain areas and hypertrophy of fat in others. We see subcutaneous fat redistribution, loss of fat, and stretching out and unveiling of the ligaments of the face as seen here. This leads to periorbital prolapse of fat that contributes to the lower eyelid “bag” and subsequent hallow underneath that is addressed with lower eyelid blepharoplasty and revolumization of the cheek in many cases.

The bony orbit becomes wider over time as bone progressively resorbs. This adds to lengthening of the eyelid and longer transition from the lower eyelid to the cheek and adds to periorbital volume loss. The maxilla (midface) resorbs as well and loses projection, which contributes to volume loss in the mid face. The orbital rim becomes more skeletonized and we see temporal hallowing as well.

Stay tuned for more discussion on how I can address these changes!

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