Hills and valleys: Understanding the under-eye

Soft tissue deflation and descent have long been implicated in the pathogenesis of facial aging. In the periorbital area, the upper orbital region is thought to change by descent of the eyebrow, as well as deflation of brow fat. While the understanding of the aging changes in the upper eyelid region are relatively simple, the lower eyelid poses a myriad of aging changes, each demanding a specific management plan. These can be best described in terms of elevations, or 'Hills' and hollows, or 'Valleys'. This article simplifies the understanding of the lower eyelid in the light of anatomical knowledge, and available literature. It forms a basis of easy diagnosis and treatment of the soft tissue changes in the lower eyelid and malar region.