Under eye bags and puffiness when smiling (Photo)

Question

When I smile, which I am complimented for my smile so I don't want to not smile, my eyes have an extreme puffiness/bags under my eyes and now and seeing lots of wrinkles over to the side of each eye...I have been trying an eye cream but need recommendations on something better or if I my need to have a procedure of some kind?

Sheila S. Nazarian, MD · Answer

Schedule a consultation with a board certified plastic surgeon in your area to be assessed in person and discuss whether or not filler in the tear trough area with some Botox to relax the muscle will deliver your desired results.  
My best,
Dr. Sheila Nazarian
@drsheilanazarian on Instagram

Adam Scheiner, MD · Answer

It seems as if the cause for your puffiness is a contraction of the muscle under the skin near the eyelashes known as the pre-tarsal orbicularis muscle.As suggested by another doctor in this thread, botox or another neuro modulator would likely help this roll when you smile.You need to make sure the doctor you see has experience with the eye region. I suggest seeing an Oculoplastic Surgeon for this treatment. Hope this was helpful.

Elliot M. Heller, MD · Answer

You may want to talk to a doctor to see if fillers may work for you. Maybe talk to them about Belotero, or what other fillers they recommend. this is something that you do not need surgery for unless it is necessary. Lower Blephs. The price for surgery starts at $3,500.

Douglas Wu, MD · Answer

Under eye bags and dark circles are certainly a tricky area to treat.  It is important to identify the cause before selecting a treatment plan.  The causes of under eye bags and dark circles are usually multiple and include volume loss, increased pigmentation, increased vascularity, and fine lines and wrinkling.  The options available to target these factors include fillers such as Restylane or Belotero, lasers for pigment and vasculature, and resurfacing, ultrasound, or radiofrequency for fine lines and wrinkling.  The wrinkling when you smile may be addressed with neuromodulators such as Botox, Dysport or Xeomin.  Combination treatments will typically achieve the best results but they must be applied in skillful and experienced hands.  In your particular situation, trying to even out naturally occurring imbalances takes a delicate touch.  Please consults with a Board Certified cosmetic dermatologist with experience in these types of treatments.  Hope that helps and best of luck!

Tanveer Janjua, MD · Answer

This is a very complicated issue and not easy to fix.  Lower eyelid blepharoplasty with extension into the cheek area to remove a lot of the excess skin can help.For less aggressive approach you can start trying Botox in the beginning with a combination of some fillers to see how much result you get.For more detail you can read below.The
dark circles happen from many different reasons. It usually is a contrast
between the surrounding pale skin and darker skin of the lower eyelids. The sun
shines down from above exposing more of the lower eyelid skin that sits on a
platform of the cheeks. This is why the football players put dark grease under
the eyes to reduce the glare effect. When you are born skin color is the same
for all of the facial skin. After years of sun exposure it starts appearing
darker than the surrounding skin. There are a few more contributing factors.
Allergies can increase blood supply leading to dark blood causing congestion
and dark shiners. Excess fat of the lower eyelid skin can cause a shadow effect
and make the dark circles look worst. 
In light of the above the treatment depends on the cause. For sun induced
darkness lasers and chemical peels help. However, exposure to sun can bring it
back. Strict daily application of sun screen and wearing sunglasses is a
must. 
If you have allergies, then proper use of antihistamines, and nasal steroid
sprays under the supervision of a physician or immunotherapy will help. 
Lastly if there is fat bulging from the lower eyelids then there are two good
options. In cases of small amount of fat, injecting a filler such as Juvederm or
Restylane just below the fat bulge in the tear trough will camouflage the bags
and hence reduce the dark circles. If there is a lot of fat then lower eyelid
blepharoplasty is a viable solution. In this procedure excess fat is excised
along with a small amount of excess skin and then lower eyelid becomes
relatively flat reducing any appearance of dark circles.

Jason Emer, MD · Answer

There are many ways t o treat dark circles, as well as under eye wrinkles and bags. It is important to note however, that the majority of times the cause for discoloration is genetic and due to the viability of the blood vessels below the skin. A combination approach is always needed to get the best results in this area and this includes: topical skin care, laser and/or radiofrequency treatments, and fillers if placed appropriately. All my patients are on topical lightening agents, typically a vitamin C serum product in the AM and a brightening agent and/or a vitamin A based product in the PM. Sun protection is essential.Resurfacing and tightening are essential. My patients get offered a menu of options, for which a combination gives the best results. Light salicylic acid peels help give textural and pigment improvement; nonablative lasers (Fraxel or Clear + Brilliant) can be used to tighten and improve fine lines/wrinkles and crepe skin; fractional radiofrequency devices (Sublative, Viva) are cutting edge and improve texture, tone, and wrinkles with very little downtime; radiofrequency with pulsed electromagnetic fields (Venus) are amazing for puffiness and bags, in patients who do not want eyelid surgery; appropriately placed fillers can replace lost volume, cover up the vessels and fat pads below improving the appearance -- patients should pick a well experienced practitioner to prevent complications such as Tyndall (blue discoloration) and irregularities, one that uses a cannula for injection will help give results with little bruising or swelling; microsecond Nd:YAG laser treatments (Laser genesis) has produced dramatic improvement in discoloration in some of my patients and is safe in dark skin types, similar to the radiofrequency devices. For lifting, ablative laser resurfacing such as co2 laser combined with monopoloar radiofrequency deep heating (thermage) give amazing results. The key is for a patient to see a cosmetic dermatologist with experience in all the latest devices and techniques so the persons goals can be met by a combination approach of individualized treatments and skin care. In some cases, those who smile and have crepe skin or under eye wrinkles, a small amount of neurotoxin (botox, dysport, xeomin) strategically placed in the lower eyelid skin can improve wrinkles dramatically and give the eye a more "open" appearance.

Anna Petropoulos, MD, FRCS · Answer

Thank you for your question regarding a very common finding as people age. You are very fortunate that according to your pictures, you don't seem to need surgery  just yet and perhaps you can prevent it altogether !  It seems that your observations are coming from skin laxity, hypertfunctioning inferior orbicularis occuli muscle and also lack of volume in your inferior lateral orbit at the cheek level.  Of course this would need to be determined on thorough evaluation in person when you visit with your Board Certified Facial Plastic Surgeon, since typically this field has the training and the background to recognize and treat these issues. Make sure the Facial Plastic Surgeon you choose is well versed both in surgical techniques but also in non-invasive techniques including facial contouring with injectables. In my opinion, you would benefit from one or two pricks of 2.5 units each  of Botox in each of your lower lids. Placement is crucial. If this is enough for you, you stop there. If you would like further improvement, you could proceed to the next step which would be radio frequency lower eyelid skin tightening with effective technologies such as Thermage, or ThermiSmooth or Fractora. After that (so that the radio frequency won't melt it if you did it before)  I would suggest placing  Voluma or Juvederm in your lateral cheek near the orbital junction. This should take care of things for you  ! Of course your Facial Plastic Surgeon will make the final determination of the right treatments for you after you have had a thorough evaluation. Best of Luck in your quest !Dr. Anna PetropoulosBoston

Medical Relations - SkinCeuticals · Answer

At SkinCeuticals, our Integrated Skincare approach is centered on the belief that a precise combination of clinical in-office procedures, professional treatments, and an advanced homecare regimen is the ideal recipe to help maintain healthy, youthful-looking skin. For this reason, we formulate our skincare for maximum efficacy alone, and as a complement to office-based treatments for enhanced outcomes. We recommend consulting with your physician to see if fillers are right for you.For your under eyes look for a product that contains vitamin C, phloretin, and ferulic acid. These ingredients will help protect the eye area against atmospheric aging caused by environmental aggressors and increase microcirculation. SkinCeuticals AOX+ Eye Gel is an innovative serum-in-a-gel created specifically for delicate skin and will help reduce the appearance of visible signs of aging around the eye. It also helps to decrease puffiness caused by excess fluid and combats signs of fatigue to restore a more vibrant, rested appearance. We would also suggest SkinCeuticals H.A. Intensifier. This product has been tested suitable for use post injectable and also helps to improve the appearance of crow’s feet, while promoting a more taut canvas and an overall refined complexion. This multi-functional serum is proven to: 1. Amplify the skin’s hyaluronic acid levels by 30%, 2. Improve the appearance of firmness and facial plumpness, 3. Help prevent the breakdown of hyaluronic acid, and 4. Visibly smoothes skin texture. In a 12-week clinical study, subjects saw an improvement in the appearance of firmness and skin texture.

Sean Paul, MD · Answer

Well, we do not want you to stop smiling! Some initial thoughts on softening the areas you have shown would be considering a neurotoxin (Botox, dysport) to soften the fine wrinkle. Hopefully this will calm some of the redundancy of the skin and underlying orbicularis that you are seeing. I would consult and eyelid or facial plastics specialist to guide you through this!  Best of luck.

Samuel Baharestani, MD, FACS · Answer

There are several different ways to approach your condition.  I would probably start with botox or xeomin injections to soften the wrinkling around the eyes.  After that, fillers or surgery may be necessary to see continued improvement.  Schedule a consultation with a board certified oculoplastic surgeon to discuss your goals.  Good luck!

Under eye bags and puffiness when smiling (Photo)

Answers (11)

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