Lower blepharoplasty to help bags while smiling? (photo)

You appear to be young and your tissues likely are very strong and elastic. Your lower eyelid position is excellent. You have only a minimal amount of lower eyelid skin creasing, and no visible fat pseudo herniation. I believe you would get an excellent improvement in your lower lids by a pinch lower blepharoplasty which could be performed under local anesthesia only, with an incision hidden just below your lash line which would be exceptionally well camouflage over time. I don’t believe anything more is needed or warranted. Best wishes.

Thanks for the questions and for providing photos.
While I understand wanting to shy away from injectables like botox or filler, I really do think this is probably the safest option before jumping into something more invasive and less reversible like surgery.
Something to consider would be under eye botox (also called "jelly roll") for the under eye wrinkles which is a relatively low risk option. Regarding the skin discoloration of the under eyes, this can be due to a number of causes including allergies, poor sleep, too much salt in the diet, etc.
And to answer some of your questions about surgery. Generally, a brow lift will not address the lateral portion of the eye (the canthus) like you are trying to demonstrate in the last video. This would likely be some type of lateral canthoplasty. And I do not think a blepharoplasty is a good option for you at this timeas your issue doesn't seem so much of the fat, but more the muscle and the skin.
I think your best bet is to meet with a plastic surgeon/oculoplastic surgeon to go over each of your concerns and discuss the best option for you.
Hope this helps,Kyle Kimura, MDFacial Plastic and Reconstructive Surgeon

Your eyebrows are too low and you would benefit from a brow lift. The incision can be extended down to the lower border of the ear to do a mid face lift, pulling the skin similar to what you are doing with your hand in the photograph. If you are still unhappy then you can consider a blepharoplasty. I do not believe there is muscle hypertrophy.

Best Wishes,

Gary Horndeski, M.D.

Yes, lower blepharoplasty can often help reduce the appearance of bags under the eyes, including those that become more prominent when smiling. Here's why and what to consider:  

How Lower Blepharoplasty Addresses Under-Eye Bags:

Lower blepharoplasty is a surgical procedure designed to improve the appearance of the lower eyelids. It typically involves:  

Removing or repositioning excess fat: The "bags" under your eyes are often caused by orbital fat that has prolapsed (pushed forward) over time. Blepharoplasty can remove this excess fat or redistribute it to smooth out the contour.  
Tightening loose skin: In some cases, excess skin on the lower eyelids can also contribute to a baggy appearance, especially when smiling causes the skin to bunch up. The surgeon may trim a small amount of this excess skin.  
Supporting underlying muscle: The procedure can also address laxity in the underlying muscles and tissues that support the lower eyelids.  
Why Bags Might Be More Noticeable When Smiling:

When you smile, the muscles in your cheeks and around your eyes (orbicularis oculi) contract and push upwards. This movement can make any existing puffiness, loose skin, or fat protrusion under the eyes appear more pronounced. Think of it like pushing on the tissue from below, making any laxity or volume more visible.

How Lower Blepharoplasty Can Help with Smiling Bags:

By reducing the underlying fat and tightening the skin, lower blepharoplasty can create a smoother and more supported contour under the eyes. This means that when you smile, there is less excess tissue and fat to be pushed upwards and become prominent.  

The easiest solution for a conservative brow lift is Botox. If you don't want Botox you can also consider Morpheus8. These treatments combine RF technology with microneedling to improve overall skin tone and texture. I've included a video on this that I hope you find helpful.

My number one and best recommendation for you is to wear daily sunscreen and avoid excessive sun exposure.
This is your absolute best remedy for a long-term solution.
I generally never recommend removing scanner from the lower eyelid.
Doing so seems to always lead to a premature atropine, which gives a very aged undesirable appearance.
It may seem like cutting out some skin to mimic the pulling you do with your fingers would be a straightforward solution, but it’s not.
It causes the lower eyelid to be pulled down.
Be very careful with this kind of surgery.
It’s a tricky area and can easily go wrong.
I think volume restoration using fillers and sunscreen are your best options.
Take a look at the work done by David Mabrie MD in San Francisco Francisco.
Real self doesn’t allow me to include links so I’ll have to look up his website.
His work using facial fillers is the best I’ve ever seen.
I consider his work to be the gold standard of what can be achieved using only fillers.
The wrinkles when you smile are not going to go away and there is no good treatment for it.
You’ll get lots of recommendations, including Botox, laser treatments, lower eyelid, plasty, etc., etc. etc.
If there was one best treatment, we’d all be doing the same thing.
Anytime, there is no easy solution for complex problems. People start offering different solutions because none of them work all that well.
The fact that somebody has one or two really good results doesn’t mean they also have a bunch of disfigured people they’re not showing you pictures of.
Number one is slowing down the rate of sun damage, which will make the condition worse.
Number two is non-surgical options.
Recognize there is no one single best treatment for wrinkles of the lower eyelid, especially associated with smiling.
Best,
Mats Hagstrom MD