Post lower blepharoplasty bag when I smile. Is this skin or muscle? (Photo)

Ihad a lower blepharoplasty ayear ago for wrinkling (no bags) I am now left with a bag which when I smile makes the suture line scar quite visible as it it quite a low scar. I have been told it is because I have strong eye muscles, a bit of the muscle needs to be trimmed. I am worried about having the muscle removed that it may cause more problems but am dissapointed I still have wrinkles and now a bag too! Is this safe or should I just leave well alone and put up with the bag?? Any advice please? TIA

Doctor Answers 7

Lower lid wrinkling

There are a few issues here. At rest you don't appear to have redundant skin, so there is probably not much excess that could be removed or you might get an ectropion.  It looks like you had fat removed, so you are volume deficient.  This increases the amount of wrinkling when you smile.  Adding filler to the lower lid may help.  You could also do some laser resurfacing to try to improve the skin texture. Botox to the orbicularis will help soften the muscle roll you see under the lashes when  you smile. When people have a very large muscle here, a small amount of it can sometimes be removed.  If too much is taken it can affect your lid tone and blinking.    

Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 24 reviews

Bag and skin muscle laxity after lower blepharoplasty

You can tailor a muscle roll, reduce lower eyelid skin laxity and move up the we cheek junction with a superficial cheek lift.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 134 reviews

Wrinkling Skin After Lower Blepharoplasty

Thank you for sharing your case and photos.  You have had the right amount of skin removed with surgery.  The bunching you see is from the underlying orbicularis oculi muscle. Some residual muscle is necessary to help you close your eyes and blink.  There are several options to treat this including surgery or Botox.  Consider a consultation with a board certified oculoplastic surgeon to discuss your options.  Good luck!

Samuel Baharestani, MD
Long Island Oculoplastic Surgeon
4.8 out of 5 stars 21 reviews

Lower lid bag

from your photo it appears you have had the maximum removal of skin as judge by your resting eyelid position.  There is always crinkling of the skin with smiling but you do appear to have more of a bag that is probably due to the muscle.  You could have your surgeon give you a trial of Botox injected into the muscle to see if you get improvement.  If you do then you could continue with botox if that is something you desire or have the muscle surgically debulked.  The surgery is relatively straight forward.  I hope this helps and best of luck.

Katrinka L. Heher, MD
Boston Oculoplastic Surgeon
5.0 out of 5 stars 7 reviews

"Eye bag"

It may be thickening of the orbicularis oculi muscle during contraction. It appears it may be more noticeable from a lack of smooth redistribution of the overlying skin during animation. This may be from the small amount of fibrosis/scarring that occurs after raising a skin-only flap to reduce lower eyelid skin wrinkles. This of course only if your surgeon used that technique. In either event, a carefully evaluated/planned/executed revision may well offer some improvement. If the question is primarily more informational then I would leave well enough alone.

Robert H. Hunsaker, MD
Miami Plastic Surgeon
4.5 out of 5 stars 69 reviews

Post Blepharoplasty concerns

It appears that you may be looking at your orbicularis oculi muscle, though pictures of you looking up would be helpful to see if it is fat, or bags.

Jeffrey Joseph, MD, FACS
Lafayette Facial Plastic Surgeon
5.0 out of 5 stars 2 reviews

Post Blepharoplasty bag

The bag you see is most likely the Orbicularis muscle under the eye and trimming it may very well correct the problem and this can be performed very simply under local anesthesia.  Wrinkling of the lower eyelid skin is difficult to correct with a lower Blepharoplasty because the wrinkling is usually caused by sun damage, aging and excessive squinting.  One cannot remove enough skin or tighten the lid enough to correct the wrinkling.  It has to be treated with a chemical or laser peel to smooth that skin.

Devinder S. Mangat, MD, FACS
Cincinnati Facial Plastic Surgeon
3.8 out of 5 stars 25 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.