Strong under eye lines and bags that mostly appear when smiling. Recommendations? (photo)

Hello! I have a nagging issue that constantly bothers me. I have bags under my eyes that are very prominent when smiling. If I am not smiling they are not as obvious but there is still some slight puffiness especially in the morning. The picture shows the top version where I am not smiling and the bottom shows smiling. Thanks for the help!

Doctor Answers 3

Very subtle eye bags

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These are subtle "eye bags". likely only from orbicularis hypertrophy and some skin laxity and not orbital fat prolapse. That being said, this can be confirmed with  a physical exam and facial analysis.  

A skin pinch lower lid blepharoplasty is a good option for you with possible periocular laser vs. chemical peel. 

Hope this helps.

Best of luck,


Chicago Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Under eye wrinkling with smiling

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When you smile, the ring muscle around the eyes bunches up and that bunching gets transmitted to the overlying skin. This is what causes the strong lines under your eyes with smiling. You can try a small dose of Botox to the central lower eyelid to prevent the muscle from bunching as much. A longer lasting solution would be to have a lower eyelid blepharoplasty and have a conservative amount of skin and muscle resected so the area is less redundant. Good luck!

Katherine Zamecki, MD, FACS
Danbury Oculoplastic Surgeon

Dark Circles, Eyelid Wrinkles/Bags Treatment -- Restylane or Belotero with Cannulas, Clear+Brilliant, Eclipse Micropen, Viva

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Laser, fillers, microneedling/PRP will give improvement without surgery. Lower blepharoplasty could be a permanent solution. Please see an expert. Best, Dr. Emer

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 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.