AAPS, American Association of Plastic Surgeons
AAPS, American Association of Plastic Surgeons
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AAPS 2007 Annual Meeting, May 19 - 22, 2007, The Coeur d'Alene Resort, Coeur d'Alene, Idaho.
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Sean J. Darcy, MD, Robert A. Goldberg, MD, J Pablo Villablanca, MD, Timothy A. Miller, MD, George H. Rudkin, MD.
David Geffen School of Medicine, Los Angeles, CA, USA.

Purpose: The etiology of aged 'baggy' eyelids has not been adequately characterized with supporting data. Current hypotheses include 1) lower lid/septum laxity with pseudoherniation of orbital fat, 2) globe descent with subsequent compression/herniation of fat, 3) fat excess. To analyze normal anatomical changes with aging, catalogued MR images were examined for changes in orbital anatomy. In this study we explore the changes of the lower eyelid with aging.
Methods: Forty patients (17 men/23 women) were imaged. 11yrs-29yrs 13(6M/7F); 30yrs-54yrs 12 (5M/7F); 55yrs-80yrs 15 (6M/9F)
High resolution orbital MRI was performed at 1.5 Tesla using the sagittal T1 sequence. We used the midsagittal slice through the right globe as the conventional image. Measurements for distance and area were used with the Centricity MRI visualization software linear measuring tool and region of interest measuring tool respectively. The average of participants in each age group was used for analysis and a student T test was performed for statistical value.
Results: Data is listed in the tables below. Statistically significant results are indicated with p values.

Age GroupsA/P Position of Globe (mm)S/I Position of Globe (mm)

A/P = Anterior/Posterior S/I = Superior/Inferior
Age GroupsArea Anterior to Mid Globe (mm^2)Fat Area Anterior to Mid Globe (mm^2)Total Periglobal Fat Area (mm^2)
55yrs-80yrs(p = 0.0093) 130(p = .0073) 42.53(p = .047) 397.9

There is no significant difference in the position of the globe within the orbit in the different age groups. In the 55-80 yr group, total lower lid area was significantly increased as well as fat area in the lower lid and overall periorbital fat area.

Conclusion: MRI data suggests that the baggy eyelids are not due to global descent or enopthalmos, but rather to an increase in volume within the orbital/lower eyelid fat compartments. Soft tissue analysis reveals an increase of the fat compartment of the lower eyelid and total periorbital fat . We speculate this may be due to adipose hyperplasia/hypertrophy that occurs with aging with subsequent prolapse of the orbital septum. Other possibilities include a shifting phenomenon from upper orbital fat to lower fat compartments.
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