The lower lid is highly susceptible to wrinkling and bagginess. At first the wrinkles appear as small lines beneath the eye and tiny crow's feet beside it. But as the skin continues to sag, the wrinkles become deeper and more pronounced. While this wrinkling is an ugly and unappealing condition, the bagginess may be even worse.

The cause of baggy lower eyelids is this: There are collections of fat both above and below the eyeball, which cushion it in the bony socket. A structure in the eyelid known as the orbital septum is supposed to keep this fat in place, but as the skin loses its tone the orbital septum weakens too, and the fat bulges into the lower lid. When light strikes from above, this bulge casts a deep shadow, so the eye not only looks swollen, but also very tired. This condition can also be inherited: sometimes patients in their twenties need lower eyelid surgery.

Another contributing factor is the accumulation of body fluid. The fat below the eye that protrudes into the lower eyelid tends to store water, especially at night when the head is lowered and gravity is unable to aid with fluid drainage. Conversely, too little fluid is also bad. Excessive drinking of alcohol causes the body to dehydrate, and this loss of water causes the skin on the eyelids to become even thinner. This allows the bulging fat pads to show through even more and makes the dark shadows and puffiness more pronounced.

These problems may be more than just cosmetically unattractive. The sheer weight of the extra skin can cause a person's eye to feel heavy or fatigued, especially at the end of a long day.

There can even be so much excess skin that it hangs down over the lid's edge and obscures the patient's field of vision. Some cases are severe enough that the individual has to tilt his head backward to see out from under his eyelids. It can also obscure vision out to the side. This condition is not only a sign of aging, but is medically undesirable and should be corrected as soon as possible.

This operation begins with an incision made just below the eyelash line. Next, the skin is uplifted from the underlying tissue, and part of the cushioning fat pads that are the cause of bagginess are removed from their compartments below the eye. Then the freed skin is drawn upward, and the resulting excess skin is carefully cut away. After everything has been completed, the surgeon closes the incision with very fine sutures.

There will be some black and blue and swelling that persists for about three weeks, although it sometimes lasts much less. You can begin to wash the area around your eyes within one week, and makeup can be applied (including some for men) in the first five days. Sometimes, tiny lumps and bumps can remain for up to two months.

Since you will feel well enough to do all your normal activities the next day, you can start wearing sunglasses immediately; and the makeup will help to hide swelling and discoloration too. Above all, don't worry about it, because all of the swelling will eventually disappear, and your eyes will be more beautiful than ever.

The ensuing scar will be almost invisible, and the excised fat will never return, so the result of the surgery is permanent.

During the operation, the surgeon must maintain a high level of concentration, because excising too much skin can lead to grave problems.

If the error is slight, the white of the eye will show through between the edge of the lower lid and the iris. While this look is unattractive, it could be much worse.

If the error is great, the lower lid will be pulled down and outward, exposing the inner portion of the eyelid. This condition (called ectropion) results in a horrible appearance of redness showing beneath the eye. But this is not a true risk of the operation because a competent surgeon will know exactly how much excess skin to remove and not a millimeter more. An ectropion can be corrected, but only with great difficulty. But once again, this kind of miscalculation is very rare with qualified surgeons, and the chance for permanent injury to the eye is really next to nothing.

On the other hand, removing too little skin is also not good, because it will leave some unnecessary wrinkles behind. But good surgeons have excellent judgment, so the operation is very likely to be successful.

Even so, a few patients may be disappointed, and this results from a lack of communication with the surgeon during the consultation. The surgeon must give the patient a realistic expectation.

The structure of the lower lid is such that not all of the wrinkles may be able to be removed, because pulling the skin up too tightly can result in the problem of ectropion just discussed. It is important for the patient to express his or her desires before the operation, and for the surgeon to discuss the possible limitations. It may happen that some wrinkles persist beneath the eye, or that only minimal changes occur in the lines beside it. In this event, you may want to have a mild chemical peel or laser treatment to get rid of them completely, but only after the surgery, not before.