Loose Lower Eyelid Skin

The problem

The lower eyelid skin sags and has excessive wrinkles, creasing, and/or folding.

Causes

Loose skin of the lower eyelid is usually a sign of aging.  There are multiple underlying factors that cause this finding, and it is rarely seen by itself without any other aging signs.  As with overall aging of the facial skin, lower eyelid skin aging is accelerated by sun exposure, smoking, and pollution.

During the normal aging process, skin becomes thinner as less collagen is produced and elastin degrades. At the same time, the fat beneath the skin begins to shrink or atrophy.  Even deeper, the bones of the face lose volume with age.  As the tissues of the face lose fullness and suppleness, the thinning skin on the surface has less underlying support. This makes the skin and muscle of the eyelid appear to deflate, sag, and wrinkle. Hollowing and shadowing beneath the eyes may also worsen.

Less common causes of loose lower eyelid skin include frequent episodes of allergy or swelling, frequent eyelid rubbing, connective tissue diseases, and certain topical medications.

Often seen with

Lower eyelid fat pouches or lower steatoblepharon, crow’s lines, lower eyelid hollowing or tear trough deformity, malar mounds or festoons, sagging lower eyelid or ectropion, loose upper eyelid skin or upper dermatochalasis, and facial fat atrophy.

Not to be confused with

Blepharochalasis (a rare syndrome with recurrent bouts of swelling), ectropion (the entire eyelid sags), or dynamic smile lines (crow’s feet).

What you see in the mirror

The lower eyelid seems to have extra skin.  You may see fine or deep wrinkles or crepiness on the lower eyelid skin.  The lower eyelid area may appear deflated.