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.

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!

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.

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.

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.

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.