Researchers Determine What Causes Baggy Eyelids

Fat expansion in the eye socket is the reason baggy eyelids come with aging, according to a UCLA research team, who advise patients looking for a cure that fat excision should be the main target of treatment for this condition.

The study is the first to examine the anatomy of multiple subjects to determine what happens to the lower eyelid with age. The effects of age on the face were also measured using high-resolution magnetic resonance imaging.

“A common treatment performed in the past and present is surgical excision of fat to treat a ‘herniation of fat’ —meaning that the amount of fat in the eye socket does not change but the cover that holds the fat in place, the orbital septum, is weakened or broken and fat slips out,” said lead author Dr. Sean Darcy, a research associate in the division of plastic and reconstructive surgery at the David Geffen School of Medicine at UCLA and a plastic surgery resident at the University of California, Irvine.

“This orbital septum weakening or herniation-of-fat theory is what most plastic surgeons have been taught. However, our study showed there is actually an increase in fat with age, and it is more likely that the fat increase causes the baggy eyelids rather than a weakened ligament,” Darcy said. “There have been no studies to show that the orbital septum weakens.”

40 people participated in the study, (17 males, 23 females) between the ages of 12 and 80 years, and the evidence showed that the lower eyelid tissue increased with age and that the largest contributor to this size increase was fat increase. The American Society of Plastic Surgeons reported that in 2007 close to 241,000 Americans had eyelid surgery, one of the top four cosmetic procedures. Many plastic surgeons treating baggy eyelids do not remove fat but reposition it, or tighten the ligament holding the eyeball in place. Meanwhile, there is no data sowing that these structures change with age.

“Our findings may change the way some plastic surgeons treat baggy eyes,” said study co-author Dr. Timothy Miller, professor and chief of plastic surgery at the Geffen School. “Our study showed that a component of a patient’s blepharoplasty procedure should almost routinely involve fat excision rather than these procedures.”

Blepharoplasty refers to surgical rejuvenation of the upper or lower eyelids, or both, depending on the extent of aging or disease. The procedure is usually performed on the lower eyelid because the most common complaint patients have is that their eyes appear tired, puffy or baggy. The surgeon makes external incisions along the natural skin lines of the eyelid to remove the excess fat and improve the contour of the lower eyelid.

“Although baggy lower eyelids are a significant result of aging and fat expansion, there are other factors that can contribute too,” Miller said. “We recommend that surgeons evaluate each component and address them accordingly in an individualized approach to blepharoplasty.”

Source: Journal of Plastic and Reconstructive Surgery, September, 2008

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