Lower blepharoplasty to help bags while smiling? (photo)

Question

My goals is to make my eyes look the way they do when I lightly pull the skin back under my eyes while smiling and at rest to correct asymmetry and puffiness as the right lower eyelid seems bigger. as well as the way I slightly pick up only the outer corner of my eyebrows. So some type of minimal brow lift for just the outside corners? And will a bleph with fat reposition help my tear troughs and get rid of the puffiness especially while smiling. Ive also heard it could be orbicularis muscle hypertrophy, but is it really when all im doing is lightly pulling skin back and it solves my problem. If it is could something like Dr. Hilinski lower eyelid muscle tuck help? I dont want to do fillers or botox.

Jeffrey M. Darrow, MD · Answer

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.

Marvin F. Shienbaum, MD · Answer

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.

Kyle Kimura, MD · Answer

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

Camille Cash, MD · Answer

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.

Gary M. Horndeski, MD · Answer

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.

Lower blepharoplasty to help bags while smiling? (photo)

Answers (6)

Answer: Considering options

Answer: Considering options

Answer: Brow lift

Answer: Brow lift

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Lower blepharoplasty to help bags while smiling? (photo)

Answers (6)

Answer: Considering options

Answer: Considering options

Answer: Brow lift

Answer: Brow lift

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Recommended reading

Everything you need to know about Eyelid Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.