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

Doctor Answers 10

Surgery best long term Option

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

Under eye wrinkles/bags

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.

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 78 reviews

Under Eye Wrinkles

First, an in person evaluation by a Board Certified physician, such as a Dermatologist, is most important.  Even if you had submitted photos of your condition, nothing beats an in person evaluation, as each person has a unique condition and facial anatomy.
With that said, common treatments for under eye wrinkles/bags/sagging include surgery, Botox, fillers and resurfacing.  Of these options other than surgery, Fractional CO2 resurfacing is likely to give you the best complete results with regards to texture, lines and tightening.  Botox MAY be effective, since your primary concern is lines with active motion, but I find this usually does not make a huge difference with under-eye wrinkles.

Jeffrey C. Poole, MD
Metairie Dermatologic Surgeon
5.0 out of 5 stars 6 reviews

I have bad under-eye wrinkles, bags and sagging when I smile. Is surgery the only option?

In order to answer your question properly, one needs to unfold the question and answer each complaint individually.  In so far as wrinkles, there are two types of wrinkles of the lower eyelid.  Ones that are there all the time whether your face is in motion or at rest, and the wrinkles that appear only when you are smiling.  The wrinkles that appear only when your smile are a good candidate for Botox treatment because, in essence, nothing else will take care of the wrinkles that appear when your skin is in motion.  However, the wrinkles that are there regardless of if you are smiling or not can be improved by laser resurfacing without the need of actual surgery.  Laser resurfacing will also address another one of your complaints, which is sagging.  Sagging can be related to issues with skin, muscle or both.  For the most part, sagging that is related to skin issues can be solved by laser resurfacing, again, without the need for a surgical procedure.  However, if there is sagging that is more involved and affects the muscle structure, there may be the need for a surgical procedure.
In so far as the bags that appear underneath the eyes, while there is the possibility that an injection of a filler can minimize the bagginess in the eyes; that is by injecting the filler in the groove that is just beneath the eyes (nasal-jugal groove), not every person with bagginess is a good candidate for it.  Bagginess is one of the issues that typically necessitates some form of surgery to improve it – typically lower lid blepharoplasty where that fatty tissue can be mobilized and placed in the correct position to minimize the debit beneath the bag and decrease the bulk of the fatty tissue within the eyelid itself.

Guillermo D. Castillo, MD
Bloomington Facial Plastic Surgeon
4.3 out of 5 stars 9 reviews

Under-Eye Wrinkles

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.

John Layke, DO, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 50 reviews

Best Treatments For Lower Lid Wrinkles

Lower eyelid wrinkles that are present at rest are usually due to loss of elasticity in the lower lid skin. Surgery may be required to remove these lines, although Fotofacial,  ThermiSmooth radiofrequency treatment, and laser resurfacing might be appropriate.  Wrinkles that develop when smiling are due to the contraction of the muscles under the lid and cheek skin. Botox, or another neurotoxin, will usually smooth these lines. If additional smoothing is desired, Fotofacial, tretinoin skin care, and laser can be considered. Surgery to remove the excess skin may be needed if the simpler procedures fail to adequately correct the problem.

Kevin L. McBride, DDS
Dallas Oral & Maxillofacial Surgeon
3.7 out of 5 stars 3 reviews

Lower lid wrinkles

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.

David Lowe, MD
Annapolis Plastic Surgeon
4.7 out of 5 stars 11 reviews

Eye wrinkles

Shelly, Should you only see this problem when you smile then Botox or an equivelent would be your best option. Should you see bags/hollowness under your eyes no matter your facial expression then a "SOOF lift blepharoplasty" would be your best option. Good luck!

M. Sean Freeman, MD
Charlotte Facial Plastic Surgeon
4.7 out of 5 stars 48 reviews

Non surgical options for under-eye wrinkles and sagging skin

In my office, the best non-surgical option for under eye wrinkles and sagging skin has been micro-needling combined with human growth factor serums. We have been getting excellent results using the Rejuva Skin Care system which combines motorized micro-needling with RejuvaCells concentrated growth factor serum made from human stem cells. Our patients also get a human growth factor serum for home use after their office treatment.
You can follow the video link above to learn more about micro-needling and human growth factor serums.

Mitchell Schwartz, MD
South Burlington Dermatologic Surgeon
4.7 out of 5 stars 12 reviews

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

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 

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 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.