42, best options for the eyes? (Photos)

Question

I am 42 years old and am a happy and active woman. I smile lots and my eyes are have just gotten worst. Is surgery the only option? They do not bulge like that when I am not smiling.

Chet Mays, MD · Answer

Thank you for your inquiry! By your photos, it looks like you would be a great candidate for an upper and lower bleph procedure as that procedure will remove fullness to your lower eyelids and excess skin to your upper eyelids. I recommend scheduling a consult appointment with a board certified plastic surgeon like myself so we can assess your eyes, listen to your goals, and create a surgical plan that is best for you and your goals!

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Dear Thrifty,

Looking at the photos and your concerns, here's a breakdown:

Upper Eyelids

Diagnosis: Dermatochalasis (excess upper eyelid skin) and early hooding.
Solution:
✅ Upper Blepharoplasty — This is the gold standard. It removes the excess skin and recontours the upper eyelid crease, helping you look refreshed but still natural.
Lower Eyelids

This area is more nuanced, but here's what I'm seeing:

Excess Fat/Bagging: Likely caused by herniated orbital fat pads.
Hyperdynamic Muscle: Smile-related bunching from active orbicularis oculi muscle—this can’t be surgically removed, but we can work around it.
Tear Trough Volume Loss: Creates the appearance of hollowing under the eyes.

Recommended Surgical Plan
Upper Blepharoplasty
     To correct hooding and improve your overall expression.
Lower Eyelid Transconjunctival Blepharoplasty
     To remove or reposition the fat pads from the inside of the lower eyelid (no visible scars).
Pinch Lower Blepharoplasty
      To conservatively remove a small amount of loose lower lid skin without compromising eyelid support.
Fat Grafting or Hyaluronic Acid Filler (e.g., Restylane)
      For subtle tear trough correction, usually performed after fat removal for optimal contour.

Andrew Miller, MD · Answer

The muscle that bulks up under the eyes when smiling is very normal. Many people have it. It's not really advisable to have surgery on it to "cut" some of it out, which could leave irregularities. Micro Botox injections usually work very well.

Nelson Lee Novick, MD · Answer

These rolls under the eyes have been nicknamed "jelly rolls" owing to their resemblance to the rounded, humped appearance of the chocolate covered jelly rim of those candy treats, which, when it comes to under the eyes, arises from contraction of the under-eye muscles, particularly when smiling. 
If this is indeed the case here, then the use of a couple of microdroplets of Botox to relax this muscle may be very helpful. I have personally been using Botox in this way for several decades for patients with this issue with gratifying results. You would be wise to consult with an experienced, board certified cosmetic dermatology injector and best of luck.

Philip S. Schoenfeld, MD, FACS · Answer

If you are referring to your lower eyelids then you can try Botox to the orbicularis muscle to reduce the "roll" effect that is occurring when you smile.  Trimming the orbicularis muscle is a surgical alternative.  Upper eyelids would require surgery and there is really no substitute.

Camille Cash, MD · Answer

From the photos it appears you would be a good candidate for Botox.  This can help minimize the full look under the eyes which is often referred to as "jelly rolls".  Be sure to see an expert injector for this treatment.

Connie Hiers, MD, FACS · Answer

Botox very carefully done can help, but surgery to trim down the muscle would be best. Please go visit with a plastic surgeon.

42, best options for the eyes? (Photos)

Answers (7)

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