How to remove the puffiness under my eyes!? (photos)

I'm only 19 years old and have these lines that lay right above my cheek bones that appear when I smile. I've had juvederm and laser treatments but nothing is working. It mainly occurs when I smile but it is so ugly I try to hide behind glasses. Please help!!!

Doctor Answers 5

Don't add volume with fillers.

These lines are from the action of different muscle groups converging when you smile. The muscle around your eye, the orbicularis oculi, creates the general crease and other lines from these are frequently targeted on the sides of the eye with botox to get ride of “crows feet.” Since you are young and have full beautiful cheeks, when you smile there are a pair of muscles that pull your cheek region into your lower lid region. These colliding mounds are likely causing your complaint.  Fillers, like Juvaderm, are best for areas of volume loss and depressions. You don't need additional volume, so fillers won't help. It’s hard to tell if you have a significant “tear trough deformity” from these pictures but that issue could be improved with fillers. Correcting that issue will probably not fix your main concern though.  You have too much volume on the sides. Neuromodulators, like Botox or Dysport, can treat lines related to muscle actions. A small dose in the orbicularis on the sides might relax the muscle around the eye and soften those lines without effecting the muscles that cause you to smile.  I would caution you on performing any surgical procedure or laser treatments to try to correct this.


San Francisco Facial Plastic Surgeon
4.8 out of 5 stars 12 reviews

Fillers

I WOULD TRY FILLERS BEFORE GOING IN AND DOING SURGERY , THE DIFFERENCE BETWEEN FAT TRANSFER AND FILLERS ARE FILLER ARE LESS INVASIVE AND CAN LAST 6-9 MONTHS SOMETIMES UP TO A YEAR DEPENDING ON WHICH ONES. FAT TRANSFERS ARE USUALLY SURGICALLY DONE WITH LIPO AND TRANSFERRED TO ANOTHER AREA OF THE BODY. A FAT TRANSFER CAN ALSO BE DONE THROUGH A LOCAL AFTER SURGERY FOR A REPEAT FAT INJECTION. FAT INJECTIONS OR TRANSFERS ARE USUALLY MORE PERMANENT. THIS IS SOMETHING THAT YOU MAY WANT TO SPEAK TO YOUR DOCTOR ABOUT IN A CONSULTATION AND SEE WHAT YOUR OPTIONS ARE.

Elliot M. Heller, MD
New York Facial Plastic Surgeon
4.6 out of 5 stars 87 reviews

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

This is often genetic but can be improved with fillers, lasers, and skin care as well as microneedling/PRP.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 167 reviews

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At this point, the problem is the prior juvederm treatment.

This is causing an extra ridge of tissue at the top of the cheek.  Please do not let this be the cause of getting unnecessary eyelid surgery.  This product should be melted away with enzyme and replaced with an appropriate Restylane treatment.  Do not do botox in this area.  Laser will not accomplish what you are looking for.  Please do not damage yourself with procedures from well meaning surgeons.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

Dynamic wrinkles when smiling

Thank you for sharing your good question. Many patients are bothered by the wrinkles cause by active movement of facial muscles (dynamic wrinkles). Depending on their location, some can be treated by Botox, fillers or lasers. On the other hand, some lines cannot be treated or only minimally diminished, but then return. This is especially true for horizontal lines on the lower eyelids and cheeks. See an experienced Oculoplastic Surgeon for comprehensive evaluation and discussion of possible treatment solutions.  Good luck,

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.