Under-eye bags
Under-eye bags are visible fullness or puffiness beneath the lower eyelids. They may be caused by protruding orbital fat, temporary fluid retention, skin laxity or a combination. Bags are distinct from tear-trough hollows, although the two can sit next to each other and increase contrast.
What you may notice
- Persistent fullness beneath one or both eyes
- Puffiness that varies during the day
- Loose or crepey lower-lid skin
- A shadow at the lower edge of the bag
- Nearby tear-trough hollowing
Why it can happen
With age, tissues supporting the lower eyelid can weaken and orbital fat may become more prominent. Genetics and facial anatomy strongly influence the appearance. Allergy, dermatitis, sleep position and fluid retention can cause fluctuating puffiness, while thyroid or other systemic disease is a less common contributor to persistent swelling.
What may help
Cold compresses, sleep and allergy management may reduce temporary puffiness but do not reposition prominent fat. Skin treatments can address texture, and selected devices may offer modest tightening. Fillers may camouflage a neighbouring hollow in carefully selected cases but can worsen oedema. Lower-eyelid surgery can remove or reposition fat and address excess skin. Choice depends on eyelid support, swelling tendency, anatomy and ocular health.
When to consult
Seek assessment if swelling is sudden, painful, red, one-sided or accompanied by vision changes, breathlessness or general illness. A specialist consultation is useful before cosmetic treatment because puffiness, fat prominence and hollowing require different approaches.
Evidence and sources
- DermNet. Dark circles under the eyes [Internet]. Auckland: DermNet New Zealand Trust; 2015 [cited 2026 Nov 7]. Available from: https://dermnetnz.org/topics/dark-circles-under-the-eyes (new tab)
- DermNet. Facial lines and wrinkles [Internet]. Auckland: DermNet New Zealand Trust; 2004 [cited 2026 Nov 7]. Available from: https://dermnetnz.org/topics/facial-lines-and-wrinkles (new tab)
- National Health Service. Eyelid problems [Internet]. London: NHS; 2023 [cited 2026 Nov 7]. Available from: https://www.nhs.uk/symptoms/eyelid-problems/ (new tab)
- American Society of Plastic Surgeons. Eyelid surgery [Internet]. Arlington Heights (IL): American Society of Plastic Surgeons; [cited 2026 Nov 7]. Available from: https://www.plasticsurgery.org/cosmetic-procedures/eyelid-surgery (new tab)