What permanent solutions can be used to minimize the appearance of under eye bags when smiling? (photos)

At home peels like cosmelan, enlighten and aerify along with dermarolling (MTS roller with anteage MD ampules) should be started now. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as lower eyelid blepharoplasty with or without fat pad repositioning will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers (Belotero, Juvederm Volbella​), lasers (Moxi/Halo/Fraxel/CO2​), Renuvion (J-Plasma), microneedling/PRP, stem cells and microneedling RF like Fractora PiXel8 or Morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. A surgical option to remove skin and/or fat might be the best solution long-term. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

If you look other people faces when they smile, you will see this happining to all of them. However, in some patients, portion of the orbicularis oculi muscle can be larger (hypertophy, frequent in myops). In some patients it may be considered to shave off a small amount of muscle. This can be decided only on the baisis of in person evaluation, discussion about your goals and risks involved. Godd luck.

Thank you for sharing your photos! I would need to examine you in-person to best answer your question. It is normal to have some creasing under your eyes with smiling. However, the very delicate skin around the eyes tends to get crepey and puffy due to fatigue and stress. Eyelid surgery has become one of my most popular procedures to remove the fat that is protruding in your lower eyelid area. Saggy and crepey excess skin can also be removed, if needed. You may also benefit from skin-tightening procedures like Thermage, which is a non-surgical technique that uses radiofrequency technology to stimulate collagen and tighten the skin under the eyes with no downtime. The use of certain topical creams can also be helpful to reduce the appearance of dark circles and puffiness around the eyes. I suggest making an appointment with a board-certified plastic surgeon experienced in surgical and non-surgical eyelid procedures.

Thank you for your question.

What you are seeing when you smile is bulging of the eyelid muscle and not a bag caused by fat underneath the eyelid.

Unfortunately the eyelid muscles necessary to support your lower eyelid and the muscle cannot be removed.

Tox injections in the crows feet area can lessen the appearance laterally or along the side of the lower eyelid.