Hooded eyes/Puffy Eyelids | Dark Circles Under Eyes/Tear Troughs | Perioral Mounds

Hooded eyes/Puffy Eyelids
Hooded eyes occur when excess fat or skin droops down from the brow bone, covering the eyelids. Hooded eyes are typically accompanied by puffy upper eyelids, thickened upper eyelids, and smaller-than-normal eyes, resulting in a sleepy and sluggish appearance.
  1. In young individuals, hooded eyes may arise from the lower positioning or overgrowth of orbital septal fat.
  2. Overgrowth of browbones is another factor contributing to hooded eyes.
  3. In the elderly, hooded eyes are primarily attributed to aging rather than septal fat overgrowth.
  4. Hooded eyes can also be linked to lacrimal glands. Inherited or acquired prolapse of the lacrimal gland may lead to hooded eyes, with aging and excessive crying being potential triggers for gland prolapse.
  5. A thick layer of deep fat tissue on the upper eyelids can cause hooded eyes, affecting about 10% of the population.
  6. Edema, which can occur from consuming salty foods or excessive water intake before bedtime, may lead to eyelid swelling the next morning.
  7. Edema resulting from poor sleep patterns, endocrine disorders, or liver and kidney diseases can also cause upper eyelid edema, contributing to hooded eyes.

Three types of hooded eyes/puffy eyelids: fat-type, muscle-type, and ageing-type.

  1. The fat-type is the most prevalent form of hooded eyes, typically inherited.
  2. Muscle-type hooded eyes are typically less puffy compared to fat-type hooded eyes.
  3. As we age, our skin undergoes a natural aging process, with the skin around the eyes being among the first areas to show signs of aging.
Dark Circles Under Eyes / Tear Troughs

Dark circles under eyes are the pigmentation deposited around the eyes. They are usually caused by tired eyes, lack of sleep, poor blood circulation around the eyes, and genetic factors.

A tear trough is a deep crease extending from the inner corner of eyes to the lower eyelid, or sometimes even to the upper cheek. It is a type of wrinkles that is caused by the sagging soft tissue at the lower eyelids. Tear trough is one of the three types of wrinkles that significantly represent the ageing process.


Causes of pigmented and vascular dark circles:

  1. Aging leads to the thinning of the skin due to the loss of fat tissue and collagen.
  2. Genetics, inflammation, and prolonged sun exposure can cause pigmentation.
  3. Conditions like allergic rhinitis, stuffy nose, and chronic sinusitis can impair blood circulation and cause the enlargement of blood vessels around the eyes.
  4. Excessive crying, high salt intake, menstruation, and pregnancy-related edema can temporarily increase the visibility of veins.
  5. Poor sleep patterns, sleep deprivation, eye strain, stress, and anemia can result in fluid retention and impaired circulation around the eyes.
  6. Conditions such as atopic dermatitis, frequent rubbing and scratching of the skin, and recurrent contact dermatitis can cause the skin to become rough.

Causes of structural dark circles:

  1. When severe tear troughs accompany dark circles, they may appear darker and more pronounced.
  • Two types of tear trough: true tear trough and tear trough with under-eye bags
    True tear trough: characterized by a depression or sunken appearance of the lower eyelid without the presence of under-eye bags.
    Tear trough with under-eye bags: characterized by the coexistence of tear troughs and under-eye bags.
    Due to the way light reflects on the skin, the depression in the tear trough area can often give the false impression of under-eye bags.
  • Types of dark circles: Pigmented, vascular, and structural.

▲ Vascular Dark Circles

Vascular dark circles occur when the thin skin around the eyes reveals underlying blood vessels, appearing pink or deep purple. Factors like sleep deprivation or fatigue can worsen vascular dark circles by reducing blood circulation and oxygen levels in the blood, leading to a bluish-red appearance of veins under the eyes.

Quick identification: Tap the dark circle lightly with your fingers. If the color becomes lighter, it’s likely vascular dark circles.

▲ Pigmented Dark Circles

Pigmented dark circles are brownish in color due to excess pigment production and accumulation in the skin. Lifestyle factors such as sun exposure, poor skincare habits, and frequent eye rubbing can contribute to their formation. They may also have a genetic component.

Quick identification: Brown discoloration appears on both upper and lower eyelids.

▲ Structural Dark Circles

Structural dark circles, also known as shadow dark circles, are caused by anatomical features like skin laxity, under-eye bags, and tear troughs. Uneven surfaces reflect light unevenly, creating shadows that resemble dark circles.

Perioral Mounds (Pockets of fat at corners of mouth)

We all acknowledge that signs of aging around the eyes are highly visible. However, we shouldn’t overlook the signs of aging around the mouth! As we age, the upper and middle portions of our face start to lose volume and definition, while the lower part appears heavier, contributing to an aged appearance.

The small fat bulges at the corners of the mouth, also known as perioral mounds, consist mainly of superficial fat pads and sagging skin due to aging. These independent fat pockets on the outer corners of the lips sometimes give the appearance of a “sheep face” or “squirrel face”.

Causes & Symptoms

Perioral mounds can result from a combination of aging and genetics.

  • Genetics: Perioral mounds are primarily composed of subcutaneous fat. When there is naturally abundant and prominent fat at the outside corners of the mouth due to genetic factors, perioral mounds may develop, giving the face a certain appearance.
  • Aging: Changes beneath the skin’s surface can contribute to an older appearance. As collagen levels decrease with age, the support provided to connective tissues and fat pads diminishes, leading to sagging skin and downward hanging of fat pads.

Perioral mounds, deflated cheeks, and downturned mouth corners may occur simultaneously. In some cases, deflated cheeks may coincide with tear troughs.

Identifying the cause of perioral mounds:

For individuals with genetic or naturally occurring perioral mounds, they may be young and have either a chubby face or a slim face with fat pockets at the outside corners of the mouth.

If perioral mounds develop later in life, accompanied by drooping mouth corners, aging is likely the contributing factor.

Affected Individuals:

  • Young individuals with perioral mounds.
  • Individuals experiencing perioral mounds due to aging.
  • Those with pronounced signs of aging around the mouth.
  • Individuals with sagging skin in the lower face area.
  • People seeking long-term treatment for anti-aging and perioral mound improvement.
  • Individuals financially capable of investing in long-term treatments.
  • Those with sagging cheeks or loose skin.
  • Individuals with visible wrinkles around the nose and mouth, aiming to address signs of aging.
  • People dealing with a double chin, jawline fat deposits, or undefined contours.
  • Those with deep fat accumulation on the face.
  • Individuals experiencing issues with edema.

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