I have bad under eye wrinkles bags/sagging only when I smile. Is surgery the only option to correct this?

Typically when someone has excessive wrinkling and skin when smiling it is due to the overactivity of the muscle and excess muscle.  The best way to treat this would be through surgery to remove the excess skin and muscle.Dr. ES

Its best you schedule an in-person consult to be fully evaluated, there are many options to correct or minimize under eye bags like Botox, fillers or blepharoplasty 

Lower eyelid wrinkles are one of the most common issues in plastic surgery.  There are multiple modalities used to improve this problem, ranging from minimally invasive to surgical correction.  If there are "bags," or pseudoherniated fat, then surgery is most likely necessary to correct this.  If there is excess skin leading to wrinkles, often accentuated with smiling, then it depends on the degree.  If there is mild to moderate skin excess, often a fractionated CO2 laser can be used to resurface and tighten the area.  If there is severe skin excess, then surgical removal of this skin (blepharoplasty) is necessary.  It is recommended to see a well-trained plastic and reconstructive surgeon to evaluate you and offer his or her recommendations to see which treatment is best for you.

It is extremely difficult to answer this question without an in office consultation or at least a photo.  There are many different treatments depending on the situation ranging from Botox, to fillers, to Fraxel, eMatrix, or surgery.  I suggest you consult a board certified physician with a great deal of experience in facial injections for the best results.

The best non surgical treatment would be Botox combined with aesthetician directed skin care.  Fractionated CO2 laser can also be added with minimal down time.