Generated by the sagging of skin, muscle, or fat around the eyelid (prolapse). Treatment of not only the skin but also the muscle and fat is necessary.

For the upper eyelid
Sagging of the upper eyelid is caused by the muscle around the eye sagging over time due to gravity, which stretches the skin. In this procedure, the skin along the eyebrows is incised, the excess skin of the upper eyelid is ablated, and the area is sutured together, smoothing the area around the eye. If there is excess fat, then the excess fat is also ablated as necessary at the same time. If the levator function—the raising of the eyelid controlled by the eyelid levator muscle—is significantly diminished, then eyelid ptosis surgery will also be conducted.

For the lower eyelid
The cause of sagging in the lower eyelid is relaxation of the muscles around the eye due to gravity and the forward protrusion of fat. In this procedure, the skin below the lower eyelashes is incised, the excess skin is ablated and the excess fat removed, and sutures are put in place. Based on symptoms, if appropriate, only the excess skin may be ablated. If there is a great deal of excess fat, then a procedure will also be conducted to remove fat from the conjunctival side.

In most cases, "bags" beneath the eyes thought at first glance to be pigmentation are really caused by the prolapse of fat and the shadows cast by the resultant puffiness and the indentations underneath. These indentations can cause the condition known as "nasolabial folds" along the cheeks. This treatment removes the protruding excess fat and injects fat into the indented area to achieve results. If the skin is sagging, it is best to conduct wrinkle removal along the lower eyelid at the same time. Other treatment for this condition aside from this procedure include injections of PRFM, b-FGF growth factor, or collagen and hyaluronic acid.