“Bags” under the eyes stem from two causes: protruding fat and excess skin.
- There is a thin layer of connective tissue that stretches from the cheekbone to the lower eyelid. Behind this connective tissue is fat which protects the eyeball. This connective tissue weakens and stretches as we age, allowing the fat to “pooch out”, resulting in bags under the eyes. The diagram below is a cross section of the eye. The big circle on top is the actual eyeball, or globe. The cheekbone is highlighted in orange, and the lower eyelid is highlighted in green (this is actually the tarsal plate, a firm supportive layer of the lower eyelid, but for our purposes calling it the lower eyelid is close enough). The blue line highlights this connective tissue layer, the orbital septum. You can see the fat behind it, highlighted in light yellow.
- Skin stretches as we age, and the excess skin contributes to bags under the eyes as well. The solution for both excess skin and protruding fat is a lower eyelid lift, or blepharoplasty. The excess skin and a small amount of fat are removed, smoothing the contour of the lower eyelid.
Dark circles also have several potential causes:
- The lower eyelid skin is very thin, so the capillaries and blood vessels show through, causing a purplish shadow. Sleeping with your head elevated on several pillows and using cold compresses can help constrict these capillaries and improve the appearance of dark circles.
- In darker skinned individuals the dark circles may be caused by excess skin pigmentation over the lower eyelid. If this is the case, laser treatments may help even out the pigmentation.
Increasing the amount of collagen in lower eyelid skin may help alleviate dark circles as well. Topical treatments such as RetinA will help increase levels of collagen. And laser treatments such as Profractional or Fraxel can also increase the amount of collagen. Dark circles can be fairly resistant to treatment, however, so you still may find that a good undereye concealer gives you the best improvement.