When I Smile or Squint the Thin Skin Under my Eyes Puffs Up into Wrinkly Bags. What Are my Options? (photo)

I have thin skin and dark circles under my eyes. When I am expressionless, I have only faint lines which I don't mind, but when I smile or squint, I have puffy wrinkly bags under my eyes give me the appearance of being 10 years older than I am. One doctor recommended IPL. Is this a good treatment for my issue or are there better options to consider? I am not completely opposed to surgery, but would prefer to try a non-surgical method first. I would appreciate any recommendations .

Doctor Answers (5)

Eyelid wrinkles

+1

No surgery is needed since the eyelids look great at rest.  Botox is the best option when there is a prominent muscle and thin skin present .  


Seattle Facial Plastic Surgeon
5.0 out of 5 stars 56 reviews

I recommend non-surgical options to treat under eye wrinkles

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Thank you for your question. You're asking what to do about wrinkly skin that becomes very puffy when you smile. This is a very common issue in my practice, especially people with lighter skin. At half a millimeter, the eyelid skin is the thinnest skin in the body and it is easily affected by a lot of factors including sun exposure, smoking, and even hydration. Based on the photos you submitted, lines are visible when your face is relaxed, which we call static lines. When you smile, those wrinkles and lines become more accentuated, and those are referred to as dynamic lines.

As a specialist in cosmetic procedures in the eye and face area, I've seen mistakes where people have skin removed thinking there was excess skin. What happens is when they smile, the skin bunches up, and if their face is relaxed, their eyelids get pulled down. This condition is called lower eyelid retraction, but I wouldn't necessarily advise cosmetic eyelid surgery. I would recommend skin treatment to improve your skin's quality.

In my practice, I routinely use fractional C02 lasers and combine it with platelet-rich plasma. This is a cutting edge procedure where we draw blood and spin it to segregate the factors that are responsible for healing. This stimulates the body's own collagen and improves the skin texture. It also stimulates blood supply to make the skin healthier.

Years ago, I highly recommended combining treatments where we try to smooth out the skin with Botox or Dysport to reduce muscle activity that causes wrinkling during the skin's healing process. It doesn't totally eliminate it as long as you're moving and smiling, so you will still have some bunching, but it is a good way to prevent things from getting worse and improve your current situation. I hope that was helpful and thank you for your question.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.5 out of 5 stars 27 reviews

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Botox Treatment for Eyelid Wrinkles and Skin Bunching

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Because you seem satisfied with your eyelid appearance when you are not smiling or squinting, I recommend Botox for the crows feet on the outer part of the eyelid. Botox can also be used for hyperactive muscles under the eye to reduce muscle bunching if treating the crows feet alone is not sufficient.

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When I Smile or Squint the Thin Skin Under my Eyes Puffs Up into Wrinkly Bags. What Are my Options?

+1

The wrinkles right at the corner of the eye are best treated with Botox. However, the wrinkles in the lower eyelid/ cheek area closer to the iris are best treated with surgery or laser treatments. Given that you want to avoid surgery, you are likely a very good candidate for laser eyelid resurfacing to tighten the skin in that area. I have found the fractional CO2 laser to be the safest and most effective laser for treatment of this area but there are other options available. I hope this information is helpful.

Stephen Weber MD, FACS

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Denver Facial Plastic Surgeon
5.0 out of 5 stars 37 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.