Understanding the Aged Lower Eyelid

When meeting a person for the first time, our mind naturally studies their face and draws conclusions on age, fatigue, and lifestyle based on clues we can find.  An aged appearing lower eyelid can overpower most other features of the face to leave a negative impression on others.

So what makes an aged appearing eyelid?  Well, baggy lower lids with wrinkled skin are the obvious answer.  But one would be wrong to conclude that the lower lid skin has just become saggy with time.  The actual situation is much more complex.  To see the difference, open a magazine and study the lower lid of a youthful model.  It appears much shorter and tighter than the aged lid right?  In actuality, it is the same length.  Over time the fat pads of the cheek have both descended and deflated.  This is the fat on the outside of the lid, and is our friend in obtaining a youthful lid.  The fat on the inside of the eyelid is part of the cushion of the globe of the eye.  Over time, this fat has herniated outward and is pushing from behind the lid.  This is not a friend of the youthful eyelid.  In addition, the actual septum of the eyelid becomes looser and bulges over time.  This bulge combined with the septum’s attachment to the bone enhances what is called the “tear trough” area of the lower lid.  This is the area between the nose and the eyelid.  It becomes a shadow and is a giveaway of an aged lid.  Lastly, the skin of the lower eyelid can become lax and excessive over time.  This is the obvious problem to someone looking at their lower lid, but in reality, very little excess skin needs to be removed.

Fortunately, obtaining a youthful lower eyelid is achievable with a combination of several plastic surgery procedures that address the precise problems.  First, the fat pads of the cheek need to be enhanced by replacing volume and/or lifting.  This can be accomplished using a number of techniques.  My most common technique is fat grafting to the cheek areas and “tear trough” area.  The fat is obtained from the neck fat (if available) through liposuction.  The fat is then purified and injected in tiny droplets to enhance and rebuild the cheek.  This is important in recreating the “short” youthful lower eyelid.

Second, the bulging fat from behind the eyelid is accessed through the mucosa of the inner eyelid.  A tiny removal of the excess fat in this area can be the difference in obtaining a great result.  From this access point, I also like to release the tether of the “tear trough” area from its attachment.  This decreased the shadow between the nose and lower eyelid and allows the remaining fat of the inner eyelid to redrape into a softer youthful position.

Lastly, the excess skin is addressed.  The skin may not need to be removed in all patients.  In reality, a lifted eyelid will create skin that the body will naturally tighten over time.  However, in most patients a tiny amount of skin will need to be removed to allow the final component of the enhanced and youthful lower eyelid to be addressed and corrected.

If you are interested in restoring a youthful appearance to your lower eyelids, please make an appointment.  During the consultation, I will perform a physical exam and we can discuss your goals and desires and create a plan to achieve them.


–Jason Mussman MD

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