Baggy lower eyelids are generally due to the protrusion of fat normally contained behind the eyelids, into the lower lid areas. Removal of this fat empties the “bags” and removal of excess skin tightens the surface of the lower lids to achieve a smoother, more youthful appearance under the eyes.

Usually, this procedure is performed by an incision on the inner side of the eyelids to remove the fat and a small incision in the outer corner of the eyelid to tighten the skin. Occasionally, an incision is needed under the lower lid lashes.

At times protrusion of lower eyelid fat is associated with a depression or hollowing over the cheekbone, producing a circle effect.  In such cases, repositioning the fat into these areas reduces the bags and fills in the depressions.

Illustrations are from Dr. Putterman's textbook "Cosmetic Oculoplastic Surgery".