What is Recommended for Inner Corner Up Eyelids and the Puffy Bags That Form Under my Eyes That ONLY Show when I Smile? (photo)

Yes you have a small knuckle of fat in the medial left upper eyelid crease.  However, you have profound upper eyelid ptosis that is so severe in actually encroaches into your visual axis.  I would recommend consulting with oculoplastic surgeons regarding the upper eyelid ptosis to determine what you need.  Well done a brighter eyed look will transform your appearance.  While you could look on the ASOPRS website to find a well trained oculoplastic surgeon close to home, I recommend finding an aesthetically oriented surgeon.  You might need to travel in your State for this.  They can also address the lower eyelid issues at the same time.

Looking at the photos you submitted, there appears to be some puffiness
in your lower eyelids. It’s not a lot of puffiness but it must be evaluated to
know what must have caused this. I also observed that you have some sagging and
pulling down of your left lower eyelid which we call lower eyelid retraction.
This is usually the case of some of my patients who have had previous eyelid
surgeries wherein their surgeon removed too much skin resulting in the lower eyelids
being pulled down.There are two aspects in the dynamic activity of the muscle actions
when someone smiles. One aspect is
wrinkling related to the activity of the muscle called orbicularis oculi
muscle. This is the muscle that surrounds the eye which is responsible for
supporting the eyelid and allowing one to blink. The wrinkles that form under
your eyes can be helped a little bit with neurotoxins such as Botox and
Dysport. Another aspect is the recruitment of skin when your cheek moves up
when the skin is pushed against the eyelid and causes wrinkles.One must understand that there is a difference between how they looked
when they were 40-years-old compared to how they look when they are 60 or 70
years old. I wrote a book few years ago called “The Fine Art of Looking Younger”
where I explained that aging is caused by many factors, including changes in
skin quality and thinning of skin as people get older. Unfortunately, many
patients look too much at the details and forget about the big picture. There
is no way to completely eliminate those wrinkles but there are strategies to
help improve the skin quality.I have been practicing for 20 years and have helped a lot of my
patients over the course of time with problems with their eyes to their sagging
of the jowls. Basically, I have become their lifetime beauty doctor. My overall
philosophy has always been critical strategic solutions that are minimally invasive
and allow for a natural appearance. I suggest that you have some fillers such as Botox or Dysport in the
depressor anguli oris muscle to have some volume enhancement. This will also
lift the lips and can also help the area around the mouth to improve the
overall appearance of the face. As far as the wrinkles under the eye that are
concerned, we typically inject something called platelet-rich plasma. This is
from your own blood that is spun down. Basically, the blood contains platelets
that are involved in healing. Platelet-rich plasma has vascular endothelial
growth factor that contributes to the healing process and helps with skin
quality. Platelet-rich plasma is not only used in the eyes but also in other
parts of the body such as the face to improve the skin texture, quality and
overall appearance. I hope that was helpful to you, and thank you for your
question.

Upper Eyelid Hollows Respond Well To Belotero BalanceUpper eyelid hollows respond well to the injection of contouring fillers, such as Belotero Balance. Belotero Balance, a hyaluronic acid based filler,has the advantage, due to certain unique aspects in the product's manufacture, to allow it to be injected even in thin areas around the eyes with little concern for the development of a bluish discoloration of the skin seen with other hyaluronic acid injectables that may occur as a result of light scattering. Although I prefer Belotero for this purpose, Restylane L and Juvederm UltraPlus XC have likewise been used successfully for this purpose, usually after dilutionIn the hands of an experienced injector, the replacement of volume in this region fills out the hollowed area restoring more aesthetic proportions between the upper eyelid and the lower portion of the brow. If desired, a test injection of a small volume of salt solution may be used to give an approximate idea of what the final result might look like following actual treatment. Improving upper eyelid hollows with injectable volumizers seldom takes more than five minutes per side.Botox (and Dysport and Xeomin) works well for the under eye crinkling that is accentuated by smiling. Treating areas around the eyes should only be performed by physicians with considerable experience in injecting this location.