We're discussing the bags under the eyes within the lower eyelids and whether or not plastic surgery can permanently correct this appearance. So, we need to first understand exactly what it is. So, when people say they have bags under their eyes, it's a combination of several things. First of all, there's fatty tissue that exists around the eyeball which is meant to protect the eyeball. However, sometimes this fatty tissue protrudes a little bit too much in the lower eyelid, either because of genetics or laxity of the muscle layer in the lower eyelid.
So, that pouching out of the eyelid fat creates what's commonly called the bags under the eyes. In addition, there is often some darker pigmentation in the lower eyelid that exists in the skin. And finally, there's a crease that exists in this area between the skin and the bone in this part of the lower eyelid. That area's called the tear trough, and when that area is particularly deep, it's called a tear trough deformity. So, when addressing lower eyelid bags from a plastic surgery perspective, all of these factors need to be considered. Getting rid of the pigmentation in the skin is very difficult. However, a part of that pigmentation is the way in which light hits the lower eyelid.
So if there is a large bag or out-pouching of fat above an indentation, then when light comes down from above, a shadow is going to be cast, and that's going to increase the appearance of dark pigmentation in the lower eye. So there are several different surgical procedures that can be used to attempt to get rid of lower eyelid bags. The first is by removing some of the fat, the second is by dividing the ligament that causes the indentation, and the third is by injecting a substance, often a filler, in order to smooth out the area of the indentation and to create a smooth lower eyelid. Finally, what we often do is tighten the lower eyelid by placing sutures within the muscle and the tendons on the side of the eye and suturing those tendons to the bone in order to support the lower eyelid, and also to make sure that the lower eyelid contour is as smooth as possible. These results tend to last a very long time.