The true "eye-bag" refers to an actual paeudo-herniation of the infra-orbital fat - the fat under the eye pushes against a fibrous wall that is meant to keep it from spilling out. This happens due to the gradual weakening of that orbital septum, together with changes in soft tissue and the bony structure of the facial skeleton over time. Often though, the fat herniation could very well be congenital and be present from youth.
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