Eye bags are specifically defined as sagging of the skin of the lower eyelid, resulting in an accumulation of fat in the orbital septum, causing the skin of the lower eyelid to droop and swell, which disrupts the normal balance between the amount of orbital fat and the supportive structures of the lower eyelid. The appearance of bags under the eyes disrupts the normal balance between the amount of orbital fat and the supporting structures of the lower lid. Bags under the eyes can be categorized as primary or secondary, with primary bags due to congenital accumulation of orbital fat and secondary bags due to aging of the supporting structures of the lower lid. Depending on the clinical presentation, bags under the eyes can be categorized into skin laxity, orbital fat bulging, orbicularis oris muscle hypertrophy and mixed types. Once bags are formed, surgical treatment is often required. Usually, according to the different types of bags under the eyes, two types of surgery are chosen: the external approach (transcutaneous approach) or the internal approach (transconjunctival approach). The bags under the eyes of middle-aged and old people have both aging skin laxity of the lower eyelid and orbital septal fat bulging and accumulation, which belongs to the mixed type, and the external approach is often used for the surgery. For the combination of tear trough bags, the external approach also requires the release of orbital fat, removal of excess skin, and correction of the sunken tear trough at the same time. The internal approach to under-eye bag removal is a transconjunctival incision, which has a short operative time, fewer complications, and quicker recovery, but is only indicated for puffy under-eye bags without skin laxity.