Getting older brings a host of changes to our bodies, including our eyelids. In fact, the most common cause for baggy eyelids, which can affect both your upper and lower eyelids, is ageing.
Eyelid bags are most often not serious although they can affect how you feel about your appearance. Making sure you get enough sleep, staying hydrated and applying a cold compress are effective home remedies for eyelid bags.
If you’re a smoker, quitting will also help as smoking causes dry eyes, which can make you rub your eyes more frequently — this increases the risk of baggy eyelids.
If your eyelid bags are very swollen, itchy, painful or red, see your GP to rule out underlying causes such as infection, allergies or thyroid disease.
In severe cases of baggy eyelids, your vision may be impaired and your doctor may recommend surgery. The type of surgery will depend on whether you have a problem with your upper or lower eyelid bags.
Age-related upper eyelid bags are caused by loss of fat in your eyelids, which makes your eyelid skin looser. Ageing can also cause your eyebrows to sink, particularly at the end of the brows where they taper towards your temples (the sides of your head behind your eyes). This is caused by muscles that support your eyebrows weakening.
Upper eyelid bags and drooping eyebrows can both obstruct your vision. A maxillofacial or plastic surgeon can assess you to determine the underlying cause and whether you would benefit from a brow lift or a reduction in eyelid skin and muscle.
Your lower eyelids comprise pads of fat that are held in place by a thin membrane. With age, this membrane weakens and the fat can bulge out under your eyelids. In addition, with age, the skin of your eyelids becomes looser and sags.
Lower eyelid surgery involves pushing the bulging fat back in and removing loose, saggy skin and muscle. The skin and muscle should be removed without exerting any downward force on the lower eyelid, which can cause it to turn outwards (ectropion).
Every surgery comes with risks. For upper eyelid surgery, there is the risk of the eyelid not closing properly due to damage of nerves in the area or the removal of too much skin and muscle.
For lower eyelid surgery, the main risk is ectropion where the eyelid turns outwards, exposing the pink eyelid margin. This is usually due to the removal of too much skin and muscle, and can lead to dry eyes.
However, it is common to have some of the eyelid margin showing soon after lower eyelid surgery but this usually resolves over four to six weeks with gentle eyelid massage. Keeping the eye well lubricated during this time, using lubricating eye drops, will help prevent dry eyes.
For both upper and lower eyelid surgery, a common side effect is swelling and black eyes, both of which will get better after about two weeks.
For eyelid surgery that involves the removal of eyelid fat, there is an increased risk of bleeding. In rare cases, this can cause bleeding at the back of the eye, which pushes the eye forward and causes blindness. Eyelid fat removal can also make the eyes look sunken once the swelling settles down.
Scarring from eyelid surgery is minimal as scars in this area heal very well and are usually hardly visible after a few weeks. In rare cases, if the cut is made too low or the cut is stitched together too tightly, it can become prominent. In people with darker skin, such as those of Black and Asian origin, there is also a small risk of keloids forming at the scar site ie a raised scar made of fibrous tissue.
You can return to work the day after your eyelid surgery. However, due to swelling and black eyes, many people prefer to wait until their appearance starts to look more normal. You can use makeup to cover up your black eyes after 48 hours and after two weeks, your eyelids should look more normal again.
Mr Andrew Sidebottom is a Consultant Oral & Maxillofacial surgeon at Spire Nottingham Hospital and formerly at Nottingham University NHS Hospitals, specialising in jaw joint (TMJ) disorders and facial pain, oral surgery, tongue tie, facial deformities and facial cosmetic surgery. He is also an active member of the research community publishing widely in leading peer-reviewed journals, as well as formerly being on the editorial board of the British Journal of Oral and Maxillofacial Surgery and being a NICE and NHS England clinical advisor.