Baggy Eyelids – 5 Most Common Causes

By: Allan E. Wulc, MD November 4, 2013 Category: Eyes

Many individuals have said, “Everyone says I look tired,” “When I wake up in the morning and look in the mirror, I look scary—it’s not me, it’s someone older that is now inhabiting my body” and “Even makeup won’t hide the dark circles under my eyes.”

Sound familiar?  We hear these complaints at least six times a day here at W Cosmetic Surgery.

Since studies have shown that the first place we look when we are assessing someone’s face is into their eyes…we understand and want to help explain why this happens. In this post, I wanted to uncover some of the most common causes to baggy eyelids.

Five Most Common Causes of Baggy Lower Eyelids

1. Allergies

Allergies—think runny, stuffed nose—cause the same response in the thin skin of the eyelids: swelling, dark circles under the eyes, and worsening of eyelid bags.

We’ve seen environmental allergies from molds, dyes, or medications cause eyelid swelling. But makeup, especially mascara and eye drops, even those prescribed by your ophthalmologist, can cause these symptoms. In many cases, itching accompanies the swelling, and the skin can appear slightly shiny, darkened, or thickened.

2. Sinus Disease

Sinus disease is incredibly common in the Philadelphia area. It is estimated by some that about half of all individuals will have sinus issues in their lives—whether it is from environmental allergies, pollutants, or preexisting anatomic problems. A cold, or polyps—nasal swelling—gives rise to obstruction to sinus drainage. Once obstructed, sinuses can become infected. Symptoms of sinusitis include “fullness”, or a pressure sensation in the head, headache, difficulty breathing, nasal stuffiness, loss of smell, and cough, among other things. The tissues of the face are sensitive and could swell due to sinus inflammation. Some sinusitis is chronic.

3. Thyroid Problems

The thyroid is a gland situated in the middle of your neck and adjacent to your throat. It regulates, among other things, the body’s rate of metabolism. Thyroid output can be unduly low, giving rise to hypothyroidism (lack of energy, slow heartbeat, hair loss, fatigue, constipation, skin changes), or high (wide eyed stare, rapid heartbeat, swelling around the front of the shins). Sometimes a previous inflammation of the thyroid can cause changes, as well.

There is a link between abnormalities of the thyroid and the eye. For some reason, orbital and eyelid tissues swell and produce abnormal quantities of a sugar-like substance (mucopolysaccharide) that causes swelling of the orbit and worsens eyelid bags, creates edema of the skin and occasionally discolors the skin.

4. Volume Loss

In many people who have lost a lot of weight, who practice extreme sports (Iron Man or ultra marathons) or who are on certain medications, the loss of volume can make the eye area appear hollow.   The bones of the face show—initially the cheek bone swelling looks good because it provides more definition to the face, but as it hollows more, the eyes look hollow and dark and give an overall unhealthy appearance to the face. Fatty deposits in the face are normal (think how full the faces of children are) and in general, heavier patients look younger!

5. Gravity

If it’s not the above, then gravity is probably the culprit. Lie down on your back and study your face with a hand mirror. If most of the issues that troubled you when you look in the mirror have disappeared, then gravity is the culprit.

Gravity pulls the eyelid fat pads out and down when you are upright. It pulls the cheeks down, and makes the area between the under eyes and the cheeks appear empty. As we get older, the ligaments and connective tissues that hold our fat in place thin and lengthen and the fat pads stretch downwards, creating multiple areas of alternating fullness and hollowness. When we lie flat, the ligaments are no longer put on and so the fat pads flow back into place. We look younger. Gravity is tough on us—but surgery can help. Best reason I know to consider intergalactic space travel in a weightless environment—our faces wouldn’t age!

Fixing Eyelid Bags

Whether your under eye bags are due to habitual, environmental, or congenital reasons, there are effective ways to get rid of them!

Here’s an example of a patient who achieved excellent results from his under eyelid surgery.

Because there are varying degrees of severity and causes to eyelid bags, not every solution or patient is the same. In my personal experience, I have seen some the best and most natural results by using a combination of treatments including fillers (Restylane, Juvederm, or the newly released Voluma), neurotoxins such as Botox, and surgical procedures such as Blepharoplasty and Laser Resurfacing.

Be sure to schedule a consultation with a trusted plastic surgeon who is especially experienced in Ophthalmic Plastic Surgery as your eyes are some some of the most delicate parts of the face. I hope this article was helpful and address some of your questions.

Allan E. Wulc, MD

About the Author

Allan E. Wulc, MD is the lead surgeon at W Cosmetic Surgery and is Quadruple Board Certified with over 25 years experience in cosmetic and plastic surgery. Dr. Wulc is a leader in his field and pioneer of new surgical techniques. His work has been featured in lectures, presentations, and publications worldwide. Find out more about Dr. Wulc.