What can I do to improve my puffy eyes and wrinkles? I'm only 22? :( (Photo)

I'm 22 and always look very tired and I get severe lines when I smile. My eyebags are puffy and look like I didn't sleep well. A doctor suggested 10 units of botox under the eyes, but won't that make the bags even more prominent?

Doctor Answers 4

The genetic cause and treatment for puffy eye bags at a young age, and possible causes of premature wrinkles under the eyes

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Puffy bags as they appear in the photos are mostly due to lower eyelid fat prolapse. In many cases it increases with aging but it in your case, it is more of a genetic trait. I’ve had patients in my practice as young as 14-years-old who had tremendous bags and I’ve done surgery to help them.

If your bags are constant and persistent, then a definitive surgical procedure will be the solution to your issue. I always tell patients who come in who have persistent puffiness that they are ready to have a procedure. Unfortunately, a lot of people try to camouflage bags that are beyond a certain threshold with fillers and they get themselves in all kinds of problems.

In my practice, I am very hesitant to start people in their early 20s with Botox®, Dysport or any other neurotoxins because I want to first look at what is causing the lines to be significant. There are two significant causes that accelerate aging: sun exposure and smoking. If you’re spending a lot of time in the sun or using tanning beds, it is highly likely that you are photoaging your skin and causing a big impact on the quality of the skin. Aging causes skin to lose collagen, blood supply until the quality diminishes and it becomes thinner. On the other hand, smoking generates carbon monoxide which literally chokes the oxygen away from your skin, and generates free radicals that damage the skin. Besides doing horrible things to your lungs and your blood vessels, its damaging effects are reflected in your skin. I can literally look at a person and know that they are smoker because of the quality of their skin as there's a graying quality. If you are smoking or spending a lot of time in the sun, it is recommended that you diminish the amount of sun exposure. You should wear sun block and stop smoking altogether.

That being said, 10 units of Botox® which is going to be divided into both eyes is not likely to make the bags look worse because it’s not a high dose. It is something that you might want to consider trying if you don’t have any of the other risk factors as I described earlier. However, Botox® reduces the activity of the muscle called the orbicularis oculi muscle. This is the muscle that works when you squint your eyes. I always educate my patients to differentiate between the activity of the muscle, and the lines that are formed when you smile. When you smile, your cheek moves up and it is almost mistakenly thought of the activity of the muscle. People would mostly come back for Botox® enhancement. When I show them the difference, then they understand that physical movement cannot be changed with Botox®. You don’t want to stop your cheek from moving up.

I think that getting additional opinions and certainly exploring the risk factors that might be accelerating the action of your skin are very important. Meet with more than one doctor and get some additional opinions. This would probably be helpful in helping you understand the situation with your eyes. I hope that was helpful, I wish you the best of luck, and thank you for your question.

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What can be done about puffy eyes and wrinkles.

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Hello and thank you for your question.
I should start by saying that I'm not sure how 10 Units of Botox under your eyes would help your situation at all. You seem to have 2 things that make your under eyes look puffy. One is herniation of fat from within the orbit. A blepharoplasty can be used to correct this. Most often this procedure is done on older individuals, as the fat tends to pooch through as we age. However there are some people, like yourself that have that condition as a matter of genetics. Once the fat is removed, it essentially does not come back. In addition, you appear to have some bunching of the Orbicularis muscle just under you lower eyelid lash margin. I call it a "Jelly roll". This can be smoothed with about 1 Unit of Botox, or can be gotten rid of permanently with excision of some of the muscle.I recommend that you see a board certified plastic surgeon in consultation to get more specific answers to your questions which can best be addressed after a thorough history and examination is performed.
Best of Luck to you!

I would recommend filler

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I would recommend against botox in this area and would advise you to consider Restylane or Belotera to tear troughs first.  From your photos you would likely achieve a good result with minimal filler needed (less than a single syringe divided between the two sides).  Be well.

Puffy eyelids

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Based on your photos it appears that you have prominent fat under the eyelids and a line known as a "tear trough."

The best treatment for this is going to be surgical correction. Botox will not treat these lines, as they are not caused by over activity of the muscles, but rather the way the muscles and surrounding tissues are inserting into your cheek bone.

A non surgical option to help mask the problem could be a trial of filler (such as Juvederm), however, this would be a temporary treatment which is not without potential for complications.

A consultation with a plastic surgeon will be helpful to evaluate and discuss what treatment options will be best for your case.

Best Regards,

Dr. Stutman

Ross Stutman, MD
Scottsdale Plastic Surgeon

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.