Puffy lower eyelids I. What is going on?

The anatomy of the lower eyelid and adjacent cheek is complex. The aging changes there are multi-tissue: skin, looser eyelid, fatty bulging from the orbit around the eye, cheek fat pad that has fallen with gravity and recession of the cheekbone with aging. As such there are multiple treatment options. Today, we will discuss the bulging fatty tissue of the lower eyelid

To summarize the anatomy of the lower eyelid and cheek—the lower eyelid bulges and the cheek loses bulge, or volume, so that the area below the eye begins to look “hollow.” 

The white dotted line is a possible incision for lower blepharoplasty, to remove or relocate part of the fat. Of note, the fat can be removed from an incision inside the eyelid as well, leaving no visible scar outside on the skin.

There is fat on the upper eyelid, bulging more commonly next to the nose as shown. It is commonly removed with upper blepharoplasty.

In a person with a dark circle under the eye, the fat can be even be moved to full the hollow area under the eyelid, adding to smoothness of the area and blending the lower eyelid with the cheek. See Puffy lower eyelids II.

For a list of risks of eyelid surgery, and further discussions, consult the American Society of Plastic Surgeons web page.

http://www.plasticsurgery.org/cosmetic-procedures/eyelid-surgery.html#content

In future articles, we will discuss lower eyelid skin, the aging changes in the adjacent cheek and surrounding areas.