Bags and bunched up skin under the eyes with smiling, what can fix it?

Mare5 a complete consultation is necessary to come up with your best course of action.  When you smile a muscle called the orbicularis squeezes showing the bunching and lines. BUT you have been smiling for years! But because you have list volume around this area the smile lines are coming to a forefront. Multiple steps can be taken and all may not be necessary for you. Botox can be used to temporarily weaken this muscle . Fillers, like bellafill, can be used to sculpt around the eyelids. Laser resurfacing can be used to tighten skin around the eyelids.

Dear Mare5:Unfortunately, beyond adolescence and the need to grow skin for an enlarging body, skin elasticity diminishes. Instead, passive and dynamic wrinkling folds the skin creating lines and creases.Until recently, only surgery would redrape the skin laxity and remove the excess. Today, the "cosmetic holy grail" of skin tightening is starting to come true; particularly on the face. "Controlled inflammation" stimulates the healing process of collagen production with thermal lasers and chemical peels. Bio-stimulation of the structural dermal molecules with retinoids and Sculptra have seen rejuvenating improvements. Fillers can volumize or fill in lines and folds. Please consult with a well experienced, Board Certified Plastic Surgeon for proper examination and a review of your options.I hope this is helpful. All the best!

Other than skin excision, lasers can help tighten the lower lid loose skin. Best to be seen in person. If you have herniated fat, then fat removal is probably necessary.