How does the lower eyelid acquire an aged appearance?

The fat pads that surround the eye are bound by a thin membrane that keeps them within the bony orbit or the eye socket. With time, the septum (thin membrane) may weaken and allow pseudoherniation of this “post-septal” fat, causing a bulgy lower eyelid. This may also be cause by a genetic predisposition to more fat, more swelling, or a weaker septum. It may also be due to hypertrophy (overgrowth) of the muscles within the eye-socket, which then push the fat out (as happens in Graves’ disease). The descent of the malar fat pad, or the fat-pad that is in the soft tissue of the upper cheek can cause a second bulge to the lower outside of the first. This is due to aging under gravity, and may be exacerbated by weightloss.