Eyebags, Shorelines, and Rocks

When we talk about eyebags, we are focused on the obvious, which is that there is a protuberant bag of tissue. However, is this really the case in the majority of situations? My answer is no. What I oftentimes see is that the lower orbital bony rim becomes exposed over time so that what we have instead is a hollowness and exposure of bone immediately below the perceived fat bag. Sometimes, yes, there is an obvious fat bag protuberance but I think this is more oftentimes not the case. An analogy to understand this better that I have heard from an esteemed colleague of mine is that when we are young the shoreline is high (i.e., we are replete with fat in our face) but as we get older the shoreline recedes exposing the rocks on the shore (i.e., the so-called eyebags).  Instead of removing the rocks, it might be better to increase the shoreline.  What is meant by this is that instead of removing the fat bags, I prefer to fill the hollowness around it so that the eyebag literally disappears from view. In about 1 in 20 cases I combine a traditional fatty eyebag removal (without an incision by the way) with fat grafting placed into the bony orbital rim.  In general, I rarely if ever only remove the fat bag, as I believe that it is insufficient to get the best results and sometimes can make someone actually look older by making them hollower.

No eyebags were removed, just fat added to the bony orbital rim.

Samuel M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To learn more about Dr Lam’s fat transfer procedures please call 972.312.8188 to schedule a consultation. If you would like to ask Dr Lam a question about facial plastic surgery please visit our Cosmetics Surgery Forum.