Are aging problems of the lower eyelid mostly due to saggy skin or is excess fat ever a problem too?
In my opinion aging problems of the lower eyelid are mostly due to a loss of fat in the upper portion of the cheek forming a hollow at the inferior aspect of the lower eyelid. The second most common cause is orbital fat which protrudes forward. Wrinkling of the skin is also a contribution but less common than the previous two. We often combined treatment for all the causes which would include reduction of orbital fat, augmentation and the upper cheek orbital groove and improvement of the skin through either resurfacing modalities or at times skin removal.
Posted by Dr. Buckingham