Liapakis IE, Paschalis EI, Zambacos GJ, Englander M, Mandrekas AD. Redraping of the fat and eye lift for the correction of the tear trough. J Craniomaxillofac Surg 2014 Oct;42(7): 1497-1502

Liapakis IE, Paschalis EI. Liposuction and Suspension of the Orbicularis Oculi for the Correction of Persistent Malar Bags: Description of Technique and Report of a Case. Aesthetic Plast Surg 2012 Jun;36(3): 546-549

The laxity of the skin to the upper and the "bags" to the lower eyelids even at younger ages can be adressed by blepharoplasty.

The upper eyelid incision is hidden within the natural fold of the upper eyelid for upper eyelid surgery and through this incision excess skin and fat are removed. If there is blepharoptosis, the ptosis will be repaired by the same incision. Because the scar follows the natural contour of the upper eyelid, it will be well camouflaged when it has healed.

The lower eyelid incision is usually hidden below the lower lashes.Through this incision, excess skin, muscle and fat are removed. Fat may also be redistributed to improve puffiness or bulges. Other adjustments such as canthopexy (eyelid tightening) may be done to correct special problems such as muscle laxity. This procedure is called trans-conjunctival lower blepharoplasty. While it is a good approach for younger patients, it cannot be used to remove the tiny wrinkles so a laser resurfacing  may be used in conjunction to tighten the skin under  or around the eyes.

Alternatively, sinking around the bony orbit of eyes can be adressed by fat grafting or a middle face lift. If the upper eyelid skin laxity is accompanied by sagging of the eyebrows, then a brow lift may be reccomended. Smoothing of crow's feet may require Botox, chemical peeling or laser resurfacing. Circles beneath the eyes caused by dark pigmentation may be treated be by bleaching solution.

High blood pressure, allergies, "dry eye syndrome", thyroid problems or diabetes can increase the risk. After your surgery, you may have a feeling of dryness/tearing or irritation in the eye. There is also a chance of a temporary reduction in eyelid sensation or impaired eyelid function. Mild swelling persists for several weeks in some cases while the most of the patients see swelling resolve in just a few days. You may use makeup within the first week to hide discoloration.

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