Under-eye bags: a test to differentiate them.

We refer to 'bags under the eyes' to denote unsightly deformations in the region of the lower eyelids. More specifically, it is a protrusion of the lower part of the eyelid. Ageing, lack of sleep, high-salt diet, genetic predisposition, medical reasons, alcohol consumption... the causes of swollen eyes can be numerous. There are two types of bags under the eyes that can occur:

• Malar Pockets/Oedema : These are temporary pockets caused by fluid infiltration at the infra-orbital rim. Of varying severity, they are very common in this area because the eyelid has great difficulty draining lymph due to the insertion of deep ligaments: the dark circle ligament and the malar ligament in its extension. Malar oedema can be triggered by smoking, an allergy (food, cosmetic...), after a salty meal, excessive alcohol consumption, by certain myorelaxant effect drugs (ex : benzodiazepines...) or in the morning following a lack of sleep. However, over time, they will stretch the skin and create a permanent skin laxity with the appearance of permanent pockets;

• Fatty Pockets : These refer to a bulge caused by the permanent presence of a deposit of soft tissue above the malar prominence, between the lower eyelid and the top of the cheek. They are usually due to a herniation of the malar fat under the lower eyelids, a result of an increase in volume of the intra-orbital fat or due to it no longer being sufficiently retained by the septum (skin relaxation). It thus slips downwards under the effect of gravity and skin ageing, when the supporting tissues sag. The gaze thus changes with the additional appearance of a slight shadow at the level of the dark circles and a drooping eyelid aspect. In some cases, the cause of these pockets can also be genetic. In this case, the bags under the eyes are linked to the conformation of the orbit.

It is not always easy to distinguish between a fluid swelling (malar oedema) and a fatty bulge (fat pockets). Among the diagnostic characteristics, they are not located in the same place. The fat pockets are located below the dark circles, on the upper part of the cheekbones on the malar bone, and disappear when lying down, whereas malar pockets are located above the dark circles.

There is also a simple test to differentiate between these two types of under-eye bags. Film yourself, standing upright, facing a mirror and looking upwards:

• If you notice that the bags under your eyes are more pronounced and visible, this is due to a prolapse of orbital fat in the lower eyelids;

• If, on the contrary, the bags do not increase in volume, it could be a case of oedema, and lifestyle, care, and nutrition advice could improve their appearance. Moreover, compared to orbital fat, the fluid in the eyelid does not change significantly in the upward and downward gaze.

• SIMON G. J. B. & co. What causes bags under the eyes? Analysis of 114 consecutive patients. Plastic and reconstructive surgery (2005).

• McCORD D. C. & co. Malar mounds and festoons: review of current management. Aesthetic Surgery Journal (2014).