General information on under-eye bags

Grease pockets

Fat pockets result from the accumulation of fat. The eye is surrounded by a fat pad that protects it from the bone walls. The eye is separated from the outside by a thin connective tissue called the septum. With advancing age, the septum distends and fat from the inside of the eye socket protrudes under the skin, forming pockets of fat.

As fat is hydrophilic, these pockets can vary according to a number of factors: a woman’s hormonal cycle, an excessively salty diet, excess alcoholic beverages, certain sleeping positions…

Malar pockets

Malar bags appear as swellings and are located at the top of the cheekbones. They are caused by poor lymphatic drainage, leading to water and fat retention, and edema formation.

This may be associated with the melting of fat from the outer canthus of the eye, the cause of the hollow eye, aggravating the difference in relief and giving the afflicted person a tired, worn appearance.

The differences between fat pockets and malar pockets

Sometimes patients come to the practice complaining of “dark circles”. In reality, they have malar bags.

To differentiate between fatty and malar bags, it’s important to note that fatty bags are located above the dark circles and disappear when lying down. Lymphatic malar bags, on the other hand, are located below the eye circles (on the upper part of the cheekbone on the malar bone).

When the eyeball is in an upright position, the fat pocket will increase in volume, while the malar pocket will not. The latter tends to diminish in volume over the course of the day, with the effect being more pronounced in the morning, due to disturbances in lymphatic circulation.

Finally, unlike fatty pockets, which are due to the externalization of intra-orbital fat, malar pockets are generally linked to a collapse of the orbicularis muscle and lymphatic edema, the cause of which is poorly understood.

Eye surgery: procedures vary according to the type of bags

Unlike their counterparts, malar pockets are not composed of fat. The surgical technique used to remove them is therefore more delicate than that used to remove fatty deposits.

During the consultation, Dr Hayot will therefore take great care to distinguish fat pockets from malar pockets, which require a specific surgical procedure.

Grease pockets

Fat pockets are removed transconjunctivally, i.e. through the conjunctiva (the red part of the eyelid). This technique allows the bag to be removed without cutting the skin, and without the risk of altering the look of the eyes. There is no scarring of the skin, and postoperative recovery is minimal. Lipofilling (micro-lipofilling) can also be performed in the case of dark circles.

Malar pockets

A sub-palpebral lift is required to restore tension to the orbicularis muscle and reduce the ptosis that causes the malar pocket. The incision is made at the ciliary margin, so that the scar quickly becomes invisible.

Do you have a question about fatty or malar bags? Don’t hesitate to contact Dr Bernard Hayot, a physician and plastic surgeon in Paris specializing in eye surgery.