• S Tudzarova-Gjorgova, G Dzokic, J Gjorgievska, V Trencev, A Naceska, and I Peev.
• Clinic for Plastic and Reconstructive Surgery, University Clinical Center, Skopje, R. Macedonia.
• Prilozi. 2007 Dec 1; 28 (2): 185-97.

BackgroundProtrusion of the lower eyelid is an aesthetic condition that is influenced by many anatomical features. Aim is to identify and categorize fat pad protrusion under the lower eyelids, and to evaluate the scoring system for determining the anatomical characteristics that will yield optimal surgical results.Material And MethodsDuring a six year period (2000-2005) we operated 42 patients with suborbital protrusion of lower eyelids. In our assessment of the fat pad protrusion we employed analysis of: prominence of the orbicular muscle, prolapse of the suborbital fatty tissue, eyelid fluid, stretching of the lower eyelid, triangular prominence in the malar region, loss of skin elasticity (tear through).ResultsOur study showed that the cause for baggy lower eyelids appearance is a group of complex anatomical changes. The cumulative contribution score used in this study allows for determination of the principal cause for the appearance of the sagging baggy lower eyelids. With this knowledge, the surgeon has the opportunity of choose the most appropriate Blepharoplasty technique in obtaining the optimum aesthetic effect.ConclusionThe cumulative contribution score for each anatomic variable show us that prolapsed orbital fat received high score in man as compared to women. The knowledge of the origin of baggy eye lids can aid surgeons in their selection of the correct facial sculpting technique in order to achieve the optimal aesthetic effect.

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