Undereye Rejuvenation (Lower Eyelid Aging)

Introduction
The lower eyelid region of the face is one of the first areas to show signs of aging. Several factors can contribute to the appearance of aging in the this area. Some patients complain about having dark eyebags at an early age. Other patients report a "dark shadow and eyebag" appeared in their mid-30's. Some patients note their skin has become crepy and saggy after years of sun-exposure and smoking. And, other patients notice their eyebags are protruding more over the years. Listed below are the main categories of why the lower eyelid ages:

Pigmentation-this can be due to excess pigment (melanin) or translucency of the skin showing vascular structures (blood vessels).
Skin Damage-crepy sagging skin is caused by loss of elastin and collagen, most commonly due to sun exposure, tobacco, and aging.
Volume Loss-the dark shadowing/eyebag between the lower eyelid and upper cheek transition (orbital rim) is due to loss of our baby fat.
Fat Pad Herniation-there are 3 fat pads under each lower eyelid. These can herniate from their proper anatomical position over time creating the "protruding eyebag". The central fat pad herniates most frequently, followed by the lateral fat pad and medial fat pad, respectively.

Treatment
Various treatments can be utilized to address each issue:

Pigmentation-several topicals creams and laser/light devices can reduce excess pigmentation or vascularity. However, correction of these changes is often limited.
Skin Damage-topical creams (retinoid family) and resurfacing lasers can repair and restore the loss of elastin and collagen. In particular, a fractional ablative resurfacing laser can yield significant results.
Volume Loss-fillers can dramatically restore the loss of baby fat, greatly reducing the darkness from volume loss as well as significanly reducing the appearance of the eyebag. A variety of products can be used successfully here. Dr Liu commonly uses Restylane or Autologous Fat Grafting.
Fat Pad Herniation-in the early stages of fat pad herniation, using filler to restore the volume along the orbital rim can correct most of the fat pad herniation. However, when herniation has become more prominent, removal and repositioning of the herniated fat pad is often addressed by surgery (transconjunctival lower lid blepharoplasty). A new treatment option is off-label use of Kybella to dissolve the fat pad.

Infraorbital Undereye Aging Treated with Soft Tissue Filler Cannula Technique-Dr. Howard Liu

Left Photo-Evolving forehead lines, crow's feet wrinkles, and volume loss of undereye.

Right Photo-Fine line filler technique used for forehead and crow's using Belotero and Refyne. Cannula filler technique using Vollure for undereye. Patient preferred not to have Botox to retain full motion of face.