The lower lid skin, orbicularis muscle, orbital septum, and orbital fat are degenerated and relaxed, resulting in varying degrees of bloating or sagging of the lower lid tissues, which is shaped like a pouch. Lower eyelid bags mostly occur in middle-aged and elderly people of both sexes, and are often accompanied by facial aging changes such as increased crow’s feet in the outer canthus, which is one of the morphological signs of aging of facial tissues. Some young people also appear under-eye bags are mostly related to family genetic factors. Classification of eye bags: 1, simple skin laxity, clinical manifestations of the lower eyelid skin inelastic laxity, accompanied by orbicularis muscle laxity, but no orbital fat protrusion displacement. 2, intraorbital fat prolapse type, mainly due to eyelid skin orbicularis orbitalis septum laxity or increased intraorbital fat, so that the orbital fat displacement prolapse in the lower eyelid to cause outward expansion or bag shape. 3, mixed type, refers to both the above two types of mixed lower eyelid bags gradually increase with age. 4.Simple orbicularis muscle hypertrophy type, mainly manifested as orbicularis muscle hypertrophy in the lower lid bloating, the skin is not loose also called “muscle eye bags”. Non-surgical treatment cannot eliminate under-eye bags, once formed, the only solution is surgical treatment, so far, there is no effective non-surgical treatment to eliminate under-eye bags, some auxiliary treatment such as eye skin maintenance, eye massage, etc. can only slow down the aggravation of under-eye bags, but almost no effect on the elimination of under-eye bags. Therefore, cosmetic eye bag surgery is the most common method to remove under-eye bags, and is also an important part of eye cosmetic surgery. Eye bag cosmetic surgery indications: healthy, mentally normal, active request for surgery of eye bags patients are suitable for eye bag cosmetic surgery. The procedure: lower eyelid bag revision surgery has two categories: external and internal incisions Trans-skin incision access flap method: wide indications, in principle, for all no contraindications to lower eyelid bag correction, can deal with the front wall of the eyelid bag (skin orbital septum) and orbital fat at the same time, the postoperative effect is reliable, preoperative design requires accurate, surgical operation skills require high, the amount of skin removal requirements moderate, the incision is very concealed, generally parallel lid The incision is usually parallel to the lid margin, along the outer row of lashes 1mm below the lid margin, and laterally in the direction of the crow’s feet at the corner of the eye. The skin incision is inconspicuous, and the swelling time is short (usually about 10 days for basic recovery), and the majority of patients can hardly find any trace of the incision after 3-6 months. Anesthesia: local infiltration anesthesia Surgery: cut the skin along the skin incision line to reach the surface of the orbicularis oculi muscle, separate the orbicularis oculi muscle surface, go down along the surface of the orbicularis oculi muscle to a point 1 cm below the inferior orbital rim, turn the flap downward to fully expose the inferior orbital rim, separate the orbicularis oculi muscle horizontally and bluntly in the direction of the orbicularis oculi fibers, expose the lower lid orbital septum, gently press the eye to see the orbital fat bulge forward, and cut the orbital septum to reveal the orbital fat. The orbital fat is then herniated by itself, followed by cutting and peeling the orbital fat periosteum, clamping the herniated excess orbital fat with a hemostatic forceps, cutting the severed end of the orbital fat, hemostatic electrocoagulation, cutting the central fat mass and then cutting some of the medial and lateral orbital fat masses as appropriate, the amount of fat removed varies from person to person. If the orbicularis muscle is relaxed, it should be simply folded and sutured, partly due to the shortening of the orbicularis muscle suspension or to do the tightening of the flap after the resetting of the skin spreading and natural alignment with the incision line, and trimming the excess skin of the outer canthus triangle, the incision should be intermittently or continuously sutured, and the incision should be covered with antibiotic eye dressing after the operation with appropriate pressure dressing. Postoperative treatment: ① Apply cold compresses and antibiotics as appropriate to prevent infection and reduce postoperative reactions, ② Change the dressing and release the bandage after 24h ③ Remove the stitches 4-6 days after surgery ④ Apply scar-softening drugs to the incision after removal of the stitches. This method is especially suitable for the type of eye bags where both skin and orbicularis muscle are relaxed. The incision line design and anesthesia are the same as the flap method. The skin and orbicularis muscle are incised along the incision line below the lid margin, and the orbicularis muscle is separated bluntly along the deep surface of the lid plate and orbital septum up to 1 cm below the infraorbital rim, so that the skin and orbicularis muscle are treated as a myocutaneous flap, and the orbital septum is exposed by flipping the lower lid flap. With the flap method, the flap is repositioned and the flap is pulled outward and upward with the flap method. At this point, the orbicularis oculi muscle can be suspended and sutured to the deep fascia or orbital periosteum above the outer canthus, and the excess uneven myocutaneous flap at the outer canthus can be trimmed, and the incision can be closed intermittently or continuously. Conjunctival approach: Mainly suitable for young people with simple orbital fat displacement or too much without skin laxity, for patients with mild skin laxity but good skin elasticity, the patient himself requires no scar or does not want to perform external approach for mild bags, this method can also be considered under the condition of adequate preoperative consultation. After surgery, there is no visible incision scar, no complications such as lid ectropion, lid ball separation, tear overflow, incomplete lid closure, lower lid recession, less tissue damage, less bleeding, but because the outer wall of the eye bag cannot be treated at the same time, the range of indications is small, not suitable for moderate to severe lower eye bags with significant laxity of the orbital septum of the orbicularis muscle. Complications of surgery: infection, bleeding, lower lid ectropion, lid ball separation, lower lid collapse (prevention is the main concern: the amount of orbital fat removed should be mastered during surgery, and if there is significant collapse of the eyelid, the cut fat can be replanted, avoid blindly pulling the orbital fat outward or hollowing it out to the depth, especially when dealing with the medial and lateral orbital fat masses. In severe cases, free fat or dermal fat grafting will be used after 3 to 6 months, depending on the clinic, to fill in the orbital fat mass (free fat or dermal fat grafting), incision scar (inconspicuous), and inadequate correction (unsatisfactory results). The canthus is not corrected in mild cases; in severe cases, it can be corrected 3 to 6 months after surgery by choosing the appropriate procedure.