Bags under the eyes are like a kind of "hernia". If a structure that should be in a closed area of the body is displaced externally from the walls of this closed area, we call it a "hernia".

Normally, there are 3 fat pads right under our eyes. The task of these fat pads is to protect our very delicate eyes from bumping into the lower and lateral walls of the bony sphere they are located in. In normal anatomy, there are 3 very important mechanisms that keep these pads under the eye. When these mechanisms are disrupted, the fat pads that should be under the eye shift forward and begin to appear as bags under the thin eyelid skin. Let's take a look at the 3 important mechanisms that keep the under-eye fat pads in place as well as their importance in treatment.

1. There is a connective tissue sheath that stretches along the lower eyelid in the form of a hammock and prevents the forward and outward movement of the fat pads under the eyes. The strength and tightness of this connective tissue sheath, which is called "orbital septum" by its medical name, is crucial for under-eye aesthetics. As this layer weakens over the years, the fat that should be under the eye may herniate forward. During lower eyelid surgeries, under-eye bags formed by the looseness of this layer can be eliminated by strengthening and repairing this layer or by tightening the lower eyelid curtain muscle that is attached to this layer.

2. The bowl-shaped bone base under the eye makes it difficult for the fat pads to go beyond the edges of the bowl and come out. As aging advances, the edges of the “bowl-shaped bone” base gradually become flatter, converging in shape to a flat plate. In that case, it becomes easier for fat pads to slide out of the bowl. In some individuals, the under-eye bone is not like a bowl, but rather flat. In such people, under-eye bags can become quite visible even in their 20s.

3. The junction of the cheek mass with the lower eyelid creates a “soft tissue wall” in front of the under-eye bags. When the cheek droops due to aging, this wall is pulled down from its location in front of the under-eye fat pads. Again, in some individuals, the cheek mass may be structurally low. It is possible to observe lower eyelid bags in these individuals even in childhood.

In addition, there is a volumetric growth of under-eye bags during the aging process. Fat pads under the eyes are anatomically different from other fat pads in the body, and they have a special vein of their own. This type of fat is called vascular (pedicled) fat. Inner cheek fat pad as well as above-eye and under-eye fat pads are such type of fat, and while all other fat tissues on the face are absorbed during aging, these can grow significantly in some individuals.

When treating under-eye bags, we make an individual planning in consideration of all these factors.

• We can reduce the amount of fat tissue in the under-eye bags or transfer the excess of this fat to places where there is tissue deficiency, such as the tear trough.

• We are able to stretch and tighten the orbital septum and the loose curtain muscle.

• We can move the drooping cheek mass back onto the under-eye bone through surgical procedures such as "MidfaceLift" and "SOOFLift" and thus reconstruct the soft tissue barrier.

• Sometimes we can reinforce the absorbed and flattened bone edges with implants or bone/cartilage fragments to reconstruct the bowl structure of the bone.

• And sometimes we can increase the subcutaneous adipose tissue volume in this area via micro-fat tissue transfer and camouflage the bags. Adipose tissue transfer can sometimes be used to compensate for the volume deficiency that occurs when the bags are removed during surgery.

In the patient group with evident signs of under-eye aging, we can do everything I mentioned above through the lower blepharoplasty incision made at the base of the eyelashes. It is also possible to treat under-eye bags that occur at a young age due to structural and genetic factors through a hidden incision on the inner surface of the eyelid and without making any dermal incisions. In the coming days, I will share detailed information about this surgery, which we call transconjunctival lower blepharoplasty and is one of my favorite procedures around the eyes.

Take good care...

... of yourself and your beauty.