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38 and Don't Like How my Eyes Are Aging. Puffiness is Worse when I Smile. Non-surgical Options?

I'm 38 and don't mind getting older -- in fact, my husband likes that I have a few wrinkles. I have very realistic expectations and would prefer not to have surgery. (At least not right now) But I'm at the point that when I look at photos of myself, I cringe at how old my eyes are starting to look. They were always one of my best features. The puffiness is worse on my left side and, weirdly enough, started after a sinus infection I had about 8 years ago. What would you suggest?

Doctor Answers 12

Rejuvenation of the Lower Eyelids in the Young

There are multiple ways of dealing with your problem. Unfortunately, your tissues are starting to descend, especially on the left. This makes your eyelid look longer than it is, as the cheek begins to look like it starts at the bony orbital rim, rather than the eyelid like normal. I would start with Botox and a filler. This will help for a while, but, you will eventually need surgery as the problem worsens.

Highlands Plastic Surgeon
5.0 out of 5 stars 4 reviews

Non Surgical Rejuvenation of the Eyes

Looking at your photos I would recommend a very conservative approach at this time.  Botox in your crow's foot region with a slight bump in unit dosing at the tail of the brow will give you a lovely "chemical" brow lift and erase the lateral wrinkles.  Depending on how deep set the rim of the eye appears under your eye you may also benefit from a small amount of filler in this region to soften the eye.  A formal exam and evaluation by a board certified surgeon is is not always knowing when to operate but typically when not to operate that speaks highly of a surgeon's artistic eye in this area.  Good luck!  Dr. Shep

Shepherd G. Pryor, MD
Scottsdale Facial Plastic Surgeon
4.5 out of 5 stars 20 reviews

Eyelid Surgery

You may have seasonal allergies and this may be causing edema around the eyes.  If you use allergy medicine, the edema is not variable in severity, then you likely have fat pads around the eyes, and surgery is the only real option.  This is a minor surgery, the eyes heal very quickly, and I recommend you see a Board Certified Plastic Surgeon for this surgery consultation and options.

Vivek Bansal, MD
Danville Plastic Surgeon
5.0 out of 5 stars 13 reviews

Botox or Dysport for Crow's Feet: Keep It Simple

My advice, when discussing initial consideration of aging changes around the eyes in the late 30's or early 40's, is to try Botox or Dysport.  There is no downtime, results are consistent, and patients are generally very happy.  Use of hyaluronic acid fillers around the eyes often contributes to or worsens "puffiness".  Although this procedure is often discussed, results are far less consistent, and can often lead to a bluish discoloration known as the Tyndall effect (which is reversible with Hyaluronidase).  Try the Botox/ Dysport first.  If not fully satisfied, a fractionated laser treatment or chemical peel, both of which involve downtime can be considered.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
5.0 out of 5 stars 61 reviews

Non surgical treatment of eyebags and loose skin

 From the photos, it appears that you have mild fat bags and excess skin of the lower eyelids.  You can use skin resurfacing techniques like chemical peels and Lasers to reduce the appearance of the lines and wrinkles as well as tightening the skin.  Be careful as treating the thin lower eyelid skin, to aggressively, can lead to scar formation and drooping of the lower eyelids.  Botox and fillers can be used and or added to the treatment recommendations.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 14 reviews

Best Treatment for Puffy and Crepe Eyelid Skin When Smiling

Hi Angela,

I would treat you with Fraxel repair laser, a premiere fractionated CO2 laser that will smooth the crepe` skin under your eyes.  It is an excellent alternative non-surgical treatment for aging eyelid skin. In many patients the results can be almost as good as surgical blepharoplasty.  It is very important to choose your treating physician most carefully in this delicate and unforgiving area.  Please see the video and web reference below.  Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
5.0 out of 5 stars 29 reviews

NonSurgical Options for Eyelid Rejuvenation

The skillful use of BOTOX and fillers can make a significant difference in the appearance of the eyes.

Laser resurfacing or skin peels can help to tighten the skin.

It is important to realize that these options are not a replacement for surgical procedures. Each procedure offers different benefits, and some combination is usually optimal. For example, you might benefit from laser and fillers to the lower eyelids and upper cheeks, while your upper eyelids might best be treated with surgery to remove the skin that is obscuring your upper eyelid.

The treatment must be individualized for each patient and it is important that you and your surgeon have a very clear discussion of your goals and the realistic expectations for each treatment option.

Get an assessment from someone who is expert in performing all these procedures (including surgery) so you can have a well defined idea of your choices and what to expect from each.

Paul C. Zwiebel, MD
Denver Plastic Surgeon
4.5 out of 5 stars 19 reviews

Non Surgical Rejuvenation of the Eyes

Based on your photos, the best non-surgical options would be a combination of botox to reduce the creasing around the eyes and the use of a filler like restylane to fill in the hollows.  Perhaps a 35% TCA chemical peel can be added to help with the fine lines. If you were willing to accept a surgical option, the combination of a fat transfer and lower eyelid (skin only blepharoplasty) pinch would be your absolute best option for removing excessive skin and restoring the lost volume around the eyes.  In our practice, this is the most reliable and long term way of managing the problem that bothers you. 

Amir M. Karam, MD
San Diego Facial Plastic Surgeon
4.5 out of 5 stars 99 reviews

Nonsurgical eyelid rejuvenation

There are several options for a nonsurgical approach to rejuvenation in the lower eyelid, and Botox is the most common one to reduce lines in the lid and 'crows feet' area. Fillers have also become a popular option to camouflage soft bags or puffiness, and fats graft along lid hollows also work out very well to maintain volume and minimize aging.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 37 reviews

You will do fabulous with just BOTOX and Under eye Restylane to start.

I would be very careful about getting cosmetic surgery or services in Shanghai.  I think you will be very pleased with what can be accomplished with non surgical treatment using BOTOX, Dysport, and the Hyaluronic acid fillers like Restylane and Perlane.  The key is the aesthetic orientation of the doctor you see.  These treatments are not commodity services but rather art forms.  Finding the doctor who performs the artful service is a big challenge.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 20 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.