What causes fine lines, wrinkles, and bags under the eyes?

Wrinkles should merely indicate where smiles have been – Mark Twain

The Anatomy of Facial Aging

As I researched the topics of fine lines, wrinkles, and bags, the information I found seemed to support that both fine lines/wrinkles and bags under the eyes are related to the anatomy of facial aging.

In my searching of the interwebs, I came across a really amazing patient education tool document created by a company called Valeant Aesthetics that helps illustrates what happens to our face as we age.


Source: Anatomy of the Facial Aging Process, Valeant Aesthetics,

Over time, the natural aging process has several affects to our underlying skeletal structure, skin, and muscelature (bone, skin, muscle, and fat).  Some of these changes are reviewed in the first article in this series What is Skin – The Basics, but some of these changes are new to our discussion.


As it relates to the topic of fine lines, wrinkles, and bags, the aging process affects our skin in several ways:

  • The top layer of our skin thins out
  • Collagen, elastin, and hyaluronic acid are produced at a slower rate (these are the components in our skin that provide the skin it’s fullness, elasticity, moist, and smooth).  Interesting fact…collagen, elastin, and hyaluronic acid are members of our extracellular matrix or ECM that essentially acts as physical scaffolding and influences the way cells interrelate with their environment through different signal pathways. 

Thinner skin and a reduction in the production of collagen, elastin, and hyaluronic acid result in skin that is more likely to wrinkle or sag.


Another interesting impact that the aging process has is on fat quantity and distribution.  The distribution of fat in our face changes over time.  This means that some areas lose fat and other areas gain fat that shouldn’t have fat in the first place.  These changes cause things like bags under our eyes or uneven contouring of skin.  The overall volume of fat also decreases (as illustrated in the image above).  As a result, this creates opportunities for skin to sag and wrinkles to form.


As with other parts of the body, over time our bone loses density (this is why when we are older, we have to be even more careful about falling down because our bones are literally more brittle).  This loss of facial bone removes the structural support needed to maintain a smooth, supple look to our face thus enhancing the appearance of fine lines, wrinkles, and bags under our eyes.

Other Factors that Can Increase Fine Lines, Wrinkles, and Bags Under the Eyes

Now that we have a high level understanding of the key changes our face undergoes in the aging process (intrinsic changes) and how that creates fine lines, wrinkles, and bags under our eyes, let’s look at some extrinsic factors that could also play a role in this equation.

Extrinsic factors are those items that are for the most part controllable, including:

Exposure to sun/Photoaging.  Photoaging is premature aging of the skin caused by repeated exposure to ultraviolet radiation (UV), primarily from the sun but also from artificial UV sources.  Exposure to UV is responsible for up to 90% of aging to the skin.  UV is composed of two different types of waves based on length, UVA (longer) and UVB (shorter) (there is a third wave called UVC but this is largely blocked by ozone).  UVB rays burn the skin and UVA rays cause long term damage to the skin.  UVA rays penetrate deep into the skin where they damage collagen which causes increased elastin production.  This abnormal production of elastin results in the production of enzymes called metalloproteinases which repair the damaged collagen but often do more harm than good because they can malfunction and incorrectly rebuild skin.  This incorrectly rebuilt skin forms wrinkles and the depletion of collagen further exacerbates the problem.  UVA radiation also creates free radicals which wreak havoc on numerous cellular processes.

Use/Exposure to Nicotine.  Smoking wreaks havoc on the skin.  It causes skin damage by decreasing blood flow to the skin which deprives tissues of needed oxygen and nutrients.  It also appears that people who smoke have fewer collagen and elastin fibers in their dermis.

Repetitive Muscle Movements.  Some wrinkles are considered expressional wrinkles and are due to subdermal muscle contraction which over time become permanent with repeated wrinkling of the skin.

Diet.  There are many aspects of our diet that can help or hurt our natural ability to fend off wrinkles, fine lines, and bags under the eyes.  For example, according to Reader’s Digest, vitamin C–rich foods reduced the risk of significant wrinkles by 36 percent.  They further cite that the more produce of all kinds you eat, the lower your odds of wrinkling.  (An interesting side note…I recently read an article that suggests eating 8-10 fruits/vegetables is the right portion size and that eating a diet high in produce can help us avoid chronic diseases or an early death).


What eating 10 servings of fruits and vegetables looks like. Source:

Other diet decisions that can impact the natural process of aging include eating foods that are rich in omega-3 fatty acids like salmon which have been found to reduce the risk of old-looking skin by 25% and cutting back on white bread and sugar.

Sleeping Position.  Sleeping in certain positions, such as on your stomach or not sleeping in an elevated position, can cause fluids to temporarily build up in unwanted areas like under your eyes.  In addition, applying repeated pressure against collagen, such as when you sleep on the side of your face on a pillow, will promote its breakdown and eventually lead to visible lines on your face.

Sleep Duration.  If you don’t sleep the full 7-8 hours your body needs at night, your circulatory system may not be given the time it needs to flush out extra fluid that accumulates while you are asleep and can lead to bags under your eyes.  In addition, a study released in 2015 from Bensons for Beds showed that sleep deprivation can lead to premature aging.

The Time of Day Also Plays a Role

Did you know that the way our face looks changes throughout the day?

An interesting study was performed in 2004 that suggests wrinkles are more visible in the afternoon than in the morning.  The authors suggest this is due to swelling that tends to occur in the morning due to the effects of gravity during sleep, i.e. wrinkles may be swollen in the morning.  The authors further suggest that facial expressions and movement throughout the day can aggravate wrinkles, thereby making them more apparent in the face in the afternoon than when we first wake up.  This research furthered the findings in a similar study done three years prior where the thickness of the skin significantly decreased on the face and arms, but significantly increased on the thighs and calves from morning to afternoon.


  1. Anatomy of the Facial Aging Process, Valeant Aesthetics,
  2. M. A. Farage, K. W. Miller, P. Elsner and H. I. Maibach, Intrinsic and extrinsic factors in skin ageing: a review, International Journal of Cosmetic Science, 2008, 30, 87–95,
  3. Frantz, C., Stewart, K. M., & Weaver, V. M. (2010). The extracellular matrix at a glance. Journal of cell science123(Pt 24), 4195-200.
  4. Kular, J. K., Basu, S., & Sharma, R. I. (2014). The extracellular matrix: Structure, composition, age-related differences, tools for analysis and applications for tissue engineering. Journal of Tissue Engineering.
  5. Tsukahara K1, Takema Y, Moriwaki S, Fujimura T, Imokawa G., Diurnal variation affects age-related profile in skin thickness. J Cosmet Sci. 2001 Nov-Dec;52(6):391-7.
  6. Biological Science Laboratories, Kao Corporation, 2606 Akabane, Ichikai, Haga, 321-3497 Tochigi, Japan.  A study of diurnal variation in wrinkles on the human face.
  7. C. Kennedy, M. T. Bastiaens, R. Willemze, J. N. Bouwes Bavinck, C. D. Bajdik, R. G. J Westendorp. Journal of Investigative Dermatology, Volume 120, Issue 4, April 2003, Pages 548-554.
  8. Canadian Dermatology Association,
  9. H. Brannon, Photoaging Causes and Treatment (September 2018).
  10. The Skin Cancer Foundation.  What is Photoaging? (January 2012).
  11. Goesel Anson, Michael A.C. Kane, Val Lambros; Sleep Wrinkles: Facial Aging and Facial Distortion During Sleep, Aesthetic Surgery Journal, Volume 36, Issue 8, 1 September 2016, Pages 931–940,
  12. The Guardian, Forget five a day, eat 10 portions of fruit and veg to cut risk of early death (Feb 2017).
  13. G. Miata, Readers Digest, The Anti-Wrinkle Diet,
  14. A. Mango (Oct 2018) 7 Genius Ways to Prevent Wrinkles While You Sleep,
  15. What’s to Blame for your Under Eye Bags?
  16. L. Mitchell, Lines, wrinkles and brown spots: Jodie Kidd shows alarming effects of sleep deprivation (May 2015),

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