Under-eye sagging is a combined change of loss of skin elasticity, protruding under-eye fat and the tear trough. Even if they look similar on the surface, when the cause differs, the approach needed — skin lifting, volume adjustment or fat correction — is completely different.
Contents
Why does under-eye sagging happen?
The skin around the eyes is among the thinnest on the face. Beneath it lies orbital fat (under-eye fat) and the tissues that support it.
- When young: the skin and surrounding tissue support the fat stably
- With age: changes in skin collagen and elastic structure + loosening of supporting tissue → under-eye fat protrudes forward (eye bags)
- At the same time, as the tear trough (the boundary between the under-eye and cheek) deepens, the contrast grows and it looks saggier than it really is
In other words, under-eye sagging is the result of combined changes in skin, fat, the tear trough and surrounding tissue.[1]
Anatomical research has found the same. When the lower eyelids of 50 cadavers were dissected, in every case (100%) the under-eye bulge was the result of under-eye fat pushing forward behind a weakened orbital septum.[3]
How can you tell which type of under-eye sagging you have?
| Type | Features |
|---|---|
| Loss of skin elasticity | The under-eye skin looks loose and drooping |
| Protruding under-eye fat | The area below the eye looks convex and bulging (eye bags) |
| Tear trough | The area between the under-eye and cheek is hollow, with a distinct boundary |
| Fine lines | Fine wrinkles stand out on the thin skin around the eyes |
| Combined type | Protruding under-eye + hollow tear trough together → a tired look |
In particular, when fat protrusion and a tear trough below it occur together, shadows form depending on the light, making the under-eye look even puffier or darker.[2]
The approach is completely different depending on the cause
| Under-eye condition | Direction to consider |
|---|---|
| Mainly loss of elasticity and fine lines | Skin elasticity and regeneration care (energy-based lifting, etc.) |
| Mainly tear trough | Volume adjustment considering the hollowness and surrounding contour |
| Mainly protruding under-eye fat | Correction considering the amount and position of fat (fat repositioning, lower blepharoplasty, etc.) |
| Pronounced skin sagging | Considering loose skin and fat together |
| Several changes together | Comprehensive assessment of skin, fat and tear trough |
Because the skin around the eyes is thin and close to the eyeball, it cannot be approached the same way as other parts of the face, and a treatment extent and energy settings suited to the skin thickness and anatomy are important.[3]
Related readingIf loss of skin elasticity is the main issue, how energy-based lifting used around the eyes works is covered in "XERF lifting: can it help with sagging around the eyes and the facial contour?" (Korean).
Related readingThe relationship between under-eye fat and dark circles is covered in "Can under-eye fat surgery help improve dark circles?" (Korean).
Common myths and facts — under-eye sagging
| What many people think… | What the evidence shows |
|---|---|
| "Under-eye fat and under-eye sagging are the same." | They don't mean the same thing. Under-eye fat is a protrusion, while under-eye sagging is a combination of several changes. |
| "Lifting alone will improve under-eye sagging." | It helps if loss of skin elasticity is the main cause, but if fat protrusion or the tear trough is the cause, those structures need to be considered too. |
| "If it bulges, the fat must be removed." | Not necessarily. The tear trough and volume below the fat need to be looked at together, and rather than simply removing fat, repositioning it is sometimes considered. |
| "Under-eye sagging = dark circles." | They are related, but dark circles can also arise from other causes such as pigment and blood vessels. The causes need to be distinguished. |
7 things to check before treatment
- Skin thickness and elasticity under the eyes
- Degree of under-eye fat protrusion
- Depth of the tear trough
- Left–right under-eye asymmetry
- Fine lines and skin condition
- How the under-eye connects with volume at the front of the cheek
- Movement of skin and fat when smiling or closing the eyes
Because the under-eye is an area that moves constantly with expression, the plan becomes accurate only when movement during expressions is checked as well as the resting state.
The order for planning under-eye care
In the clinic, I approach it in this order.
- Identify the cause of "why it looks that way" — skin? fat? tear trough? combined?
- A case where fat barely protrudes but the tear trough is deep and a case with fat protrusion plus skin laxity need different approaches
- Assess the contribution of each — skin, fat and tear trough
- Rather than simply tightening the skin, plan the line running from the under-eye to the cheek together
The goal is a result that looks refined, not pulled.
What I stress most often in under-eye consultations is that "even if the result looks equally puffy, the causes can be completely different." Especially from the late 30s, fat protrusion and a deepening tear trough often progress at the same time, and in that case removing fat alone can actually make the hollowness stand out, so fat repositioning tends to be favorable. When looking at the under-eye, an accurate plan comes only from examining it at rest, when smiling and with the eyes closed.[4]
Under-eye sagging is a result created together by skin, fat and the tear trough. Even if it looks similar, different causes need skin lifting, volume adjustment or fat correction respectively. Identifying "why it looks that way" is the starting point of the plan.
🔬 Supporting research
Peer-reviewed international journal articles that support this article. Click a title to open the PubMed abstract.
- Aesthetic Plastic Surgery 2023 — anatomical study of 50 cadavers Anatomical Basis for the Lower Eyelid Rejuvenation. Key finding: under-eye bulging was fat protrusion behind a weakened orbital septum in every case — 3 patterns in the number and shape of fat compartments In text [3] · PMID 36877228 · DOI
- Clinics in Plastic Surgery 1996 — surgical concept paper The role of orbital fat preservation in facial aesthetic surgery. A new concept. Key finding: the concept that preserving and repositioning under-eye fat instead of removing it can reduce hollowness and an operated look In text [4] · PMID 8617025
🎬 Watch — Dr. Park Seong-Soo · BongBong Plastic Surgery
Related videos from BongBong Plastic Surgery's official channel and Dr. Park Seong-Soo's channel. Videos are in Korean and play on YouTube.
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1:00 Under-eye hollows and dark circles solved in one go! (Korean) (Korean) Dr. Park's channel · 2025.07.25 -
0:59 Revealed: how camera-ready celebrities care for their under-eyes (Korean) (Korean) Dr. Park's channel · 2025.07.27 -
1:23 Why do pillow marks last longer on the face as we age? (Korean) (Korean) BongBong official · 2018.09.05
Frequently asked questions (FAQ)
Why does under-eye sagging get worse with age?
Changes in skin collagen and elastic structure and reduced support from tissues around the eyes progress together, and when protruding under-eye fat and tear-trough changes are added, it becomes more noticeable than before.
Are under-eye fat and under-eye sagging the same?
They don't mean the same thing. Under-eye fat is orbital fat protruding forward, while under-eye sagging can include a combination of several changes such as skin elasticity, fat and the tear trough.
Will lifting alone improve it?
If loss of skin elasticity is the main cause, lifting is considered, but not all under-eye sagging is a skin problem. If there is fat protrusion or a tear trough, those structures need to be considered too.
If the under-eye bulges, must the fat be removed?
Not necessarily. Not only the amount of fat but also the tear trough and volume below it need to be looked at, and in some cases repositioning the fat is considered rather than simply removing it.
Are under-eye sagging and dark circles related?
They can look related. As fat protrudes and the tear trough deepens, a shadow forms at the boundary and it can look dark. However, dark circles also have other causes such as pigment and blood vessels, so they need to be distinguished.
📖 References
Click a [number] in the text to jump to its source, and ↩ to return. Only papers whose title, journal and year were verified on PubMed are listed.
- ↩ American Society of Plastic Surgeons. Eyelid Surgery (Blepharoplasty). plasticsurgery.org— clinical guide to eyelid surgery
- ↩ American Academy of Ophthalmology. What Are Bags Under the Eyes? aao.org— patient guide to under-eye fat and dark circles
- ↩ Coban I, Derin O, Sirinturk S, Pinar Y, Govsa F. Anatomical Basis for the Lower Eyelid Rejuvenation. Aesthetic Plast Surg. 2023;47(3):1059-1066.PMID 36877228 · DOI— 50 cadavers — under-eye bulging is fat pushed forward behind a weakened orbital septum (100%)
- ↩ Hamra ST. The role of orbital fat preservation in facial aesthetic surgery. A new concept. Clin Plast Surg. 1996;23(1):17-28.PMID 8617025— the concept of reducing an operated look by preserving and repositioning fat instead of removing it
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