19 with Under Eye Bags/wrinkles: What Should I Do? Is It Normal?

When I smile it only gets worse. I use moisturizer with SPF 15 everyday and use mineral makeup. I also make sure to get plenty of sleep. i don't know what to do.

Doctor Answers 12

Pause before rushing into surgery

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Your eyes look youthful and normal. Do nothing for now. If your eyelids still bother you in a few years, then careful placement of Botox to relax the muscle around your eyes and laser skin resurfacing would help. You may have to repeat the injections of Botox every 4-5 months to maintain its effectiveness. All the best.

Botox, skin pinch, laser or fillers

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Botox can prevent the muscles under the lower eyelid from bunching and can reduce the wrinkles for a while. You can also get a laser peel there and will tighten up the skin in the area. A skin pinch can reduce the skin in this area also.

At age 19, a loss of volume from aging would be a little early for you. If this was the case, and you can find this out by looking at your pictures when you were younger to see if volume has decreased, you can add volume to the lower eyelid region with fillers and fat transfer. Given that you are so young most will likely suggest botox, skin care, sun protection. It would be better if you would send in pictures of yourself without smiling and you can tell how much volume you've lost in the lower eyelid area.

Philip Young, MD
Bellevue Facial Plastic Surgeon

No surgery! Botox and skin care

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The small lower lid bag that you have is not an aging sign but rather a healthy orbicularis muscle. The outer wrinkles could be improved with botox.

I would not recommend any surgery in this young age. Some skin tightening ,botox should help. Hope that helps!

Young with wrinkles

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There are many causes of these eye wrinkles. The most common someone your age is eczema or topical irritation whether it be from eyeliner or makeup remover. Try not to manipulate the area at all. If you could take a 2 wk vacation and where no makeup and not touch the eye at all I bet you would see some improvement.

You have fair skin and it seems like you are doing a good job with skin care. I would even use a 30spf moisturizer. 

One option is laser resurfacing for this. It helps to tighten the skin and remove some of these fine lines. There are also lotions with Vitamin A in them that help to turnover the skin cells more quickly. Below are some common causes and ways to treat eye wrinkles and bags but again with your age and from your photos I feels yours is most likely a topical issue. You would need a physical exam and a consult to fully determine. 

1. Prolapsed orbital fat through the orbital septum: treated with lower lid blepharoplasty and fat repositioning. Can also be helped with fillers or auto fat transfer to the face but the ideal treatment in my hands is surgery for this issue.

2. Eczema: much more common in young people with fair skin. The treatment for this is to hold off on makeup and any manipulation of the lower lid for a few weeks and try some topical anti inflammatory creams. If you have allergies those should be treated also.  A dermatologist is the best person to see for this. We have a multidisciplinary clinic with myself, a plastic surgeon, and my partner, a dermatologist which I think is ideal!

3. Fluid accumulation and/or redundant skin. Could be possible in young patients but would need a good facial analysis and exam to determine. A low salt diet (< 1000mg/day) and a warm compress can help.  I would consider treating with filler/fat transfer, lower lid fractional ablative laser and/or lower lid blepharoplasty.

4. Descent of midface cheek pad. This then causes the nasojugular ligament to become more prominent creating a demarcation and separation of the eye from the cheek subunit. Treated with mid face lift and fat transfer.

It is all about the balance of this transition from the orbit to the cheek. There are many ways to treat this and they vary by the underlying cause. I recommend seeing a surgeon who also does a lot of these treatments. This can make a big difference as most people have a combination of the above that lead to the issue.

Hope this helps.

Best of luck,


Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 12 reviews

I have lower eyelid bags / wrinkles. Is surgery the only option?

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Lower Eyelid Bags can be caused by many different issues. Sometimes a combination of issues are contributing. In your case, the wrinkles are cause by a normal, active muscle called the orbicularis coulee muscle. This muscle causes wrinkling in the very thin skin of the lower eyelid. Relaxing this muscle with a "mini" botox treatment as well as improving the resiliency and elasticity of the skin with daily topical maintenance will really help.

Jeffrey M. Joseph, MD
Newport Beach Oculoplastic Surgeon
5.0 out of 5 stars 17 reviews

Youthful Eye Wrinkles. Botox a Great Option

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Thank you for your pictures.  The lower wrinkles that you are seeing are caused by your orbicularis muscle.  This is, believe it or not, a very youthful finding.  Eye Bags in older patients are found much lower down on the face.  One option is to strategically place a little Botox or Dysport to the lower eyelid to soften this contraction.  It's important to see a board-certified plastic surgeon or dermatologist who has performed injection around the eye.  If its overdone, it could cause problems with eyelid closure.  Best of luck to you!  Dr. Pacella

Under eye bags at 19

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Based on your photo, it appears you have a muscle roll under the eyelid.  The orbicularis muscle is the eyelid muscle and in younger individuals it can present as a roll when smiling.  Botox, Dysport, or Xeomin can help relax the outside of the muscle and lessen the roll.  Surgery is not indicated for your eyelid. 

Avoid surgery on your eyelids

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In your case, the wrinkles you see have less to do with aging and more to do with the underlying muscle of your eyelid which can cause the skin to "bunch".

I'd recommend some topical skin treatments to help tighten the skin, and a very little Botox in the area (depending on how things looked when you weren't smiling).  I would avoid surgery, especially on the lower eyelids, until it was absolutely necessary.

Age 19 with Eye bags and wrinkles

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At age 19, you do not need any surgery on your eyelids. Lower eye lid surgery is performed at rest, not upon animation. The primary goal of  lower blepharoplasty surgery is to remove the fat through a trans-conjunctival  approach. The secondary goal is to remove any excess skin that may be present at rest, through an external incision at the lash line. This is called a pinch technique which is closed with tissue glue. For many examples, please see the link below to her eyelid  surgery photo  Gallery

Lower eyelid Botox or blepharoplasty in Los Angeles

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Botox or Xeomin injections may be your best bet in reducing dynamic wrinkles around the eyes and crows feet. Raffy Karamanoukian, Los Angeles

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.