Age-related orbital fat expansion contributes to lower eyelid prominenceAge-related orbital fat expansion contributes to lower eyelid prominence

Study results showed that the size of the inferior periocular soft-tissue area anterior to the globe axis increased with age

A component of treating baggy eyes or "eyelid fat herniation" is conservative fat removal

LOS ANGELES — A recently published study conducted by researchers at UCLA has found that a significant increase in anterior inferior periocular soft-tissue volume occurs with aging. A main contributor to this increase in volume is fat expansion. Using magnetic resonance imaging (MRI), the researchers found that orbital fat expansion occurs with age and is the main age-associated contributor to lower eyelid prominence (Figure 1).

VALIDATING VOLUME

In the past, theories regarding the cause of lower eyelid prominence with aging included progressive orbital fat hyperplasia/hypertrophy or swelling caused by edema, weakening of the orbital septum causing an anterior herniation of orbital fat, and globe descent with orbital fat compression and subsequent anterior herniation.

"There were many theories, but none were actually validated by data. With the correct anatomical data, we can focus on the correct solution. We chose high-resolution orbital MRI to see the finest detail changes of the anatomy," says Sean Darcy, M.D., plastic surgeon at UC Irvine Medical Center and lead investigator of the study.

"In the periorbital area, blepharoplasty surgery traditionally was used to remove 'excess fat.' More recently, our group and others have focused on volume loss in the periorbital area, adding volume with fat grafts, fat injections and synthetic fillers. We hoped, in this study, to provide better understanding of the role of volume changes in the orbital fat. Understanding the anatomic nature of aging changes can help to guide surgical and nonsurgical rejuvenation techniques," adds Robert Goldberg, M.D., chief of orbital and ophthalmic plastic surgery and co-director of the aesthetic reconstructive surgery service at UCLA's Jules Stein Eye Institute, who conducted the study with Dr. Darcy.

The study included 40 people between the ages of 12 and 80. Seventeen were men, and 23 were women. Patients were divided into three groups according to age. Thirteen people (6 men and 7 women) were between the ages of 12 and 29 years. Twelve people (5 men and 7 women) were between the ages of 30 and 54 years, and 15 people (6 men and 9 women) were between the ages of 55 and 80 years.

The orbital anatomy of the study participants was measured with high-resolution orbital MRI. The baseline area of the globe in the study participants between the ages of 12 and 29 years was 456 mm2 , and no significant changes were observed with age (463 mm2 in patients between the ages of 30 and 54 years and 456 mm2 in the patients between the ages of 55 and 80 years).

In contrast, the size of the inferior periocular soft-tissue area anterior to the globe axis increased with age. It measured 99 mm2 in the study participants between the ages of 12 and 29 years, 103 mm2 in those between the ages of 30 and 54 years, and 131 mm2 in those between the ages of 55 and 80 years, which was statistically significant.