Under my Eyes Looks Terrible when I Smile. Why? (photo)

In a resting facial position my eyes look fine but when I smile I look terrible. The skin bunches up to give me bags and wrinkles. I just took these pictures after I have sat with cucumbers and cold tea bags. What you see in the pictures is not as bad as it can be on some days. I am only 26 and have been with this issue for 2 years. It's a shame that I avoid smiling. What can I do? Should I get Restylane? I read that it may help. I am scared this will get worse with age if i don't do something.

Doctor Answers 19

Lines around the eyes can be treated in a young person with Botox or Dysport

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Botox and Dysport work by relaxing the muscles that create lines around the eyes. This reduces the wrinkling. In older patients, we need to be careful treating lines in the lower eyelids. The fat that creates eye "bags" starts to pooch out in the 30's to 40's. Relaxing the muscle around the eye (orbicularis muscle) can make those bags look worse. Whats good about these treatments is that if you don't like the results, it will wear off in a few months. The bad thing is that patients usually like the results and it....wears off in a few months.

New York Facial Plastic Surgeon
4.9 out of 5 stars 134 reviews

Crinkles under eyes

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Thank you for the photos! First, never avoid smiling. Even if it causes crinkles, you'd rather have people think you have a crinkle or two, rather than are surly or unhappy, right? Crinkles like yours can be treated. Seek a board-certified physician to evaluate you in person, but I would think some Botox or Dysport by the crow's feet, and some Restylane under the eyes would be extremely helpful. I have many patients who are treated in their mid- to late-20s, so it's not unusual to seek something at this point in time, and since many of the lines are dynamic at this point (happening when you move the muscle), treating them now will help prevent them from becoming static (there all the time).


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I  think the best treatment option for you would be to first make sure your eyesight is good. u might be squinting to get the perfect vision and u may or may not be aware of that. second of all, if your eye sight is fine and its just lines that can be made better with Botox. common procedure these days it should not be a problem to find a BC dermatologist or plastic surgeon to do your botox. fillers can be used but Im not sure u need that  

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Recommendations for Wrinkles Around the Eyes

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Hi Sweet.  We have several recommendations.  The first is Botox or Dysport to the crow's feet, the wrinkles at the outer eyes (smiles lines).  For the area under the eye, we recommend Restylane injections.  They will provide the volume you need to improve the appearance of the under eye are when smiling.

Finally, for something a bit more dramatic, we would use Profractional Laser resurfacing to tighten the skin under the eyes.  

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Eye Wrinkles

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With repeated muscular contractions, the overlying skin creases. This is what’s happening with you. Every time you smile, you squint a bit, and that forms all of those wrinkles. If the skin didn’t wrinkle, your smile would probably not look as genuine. For that reason, it’s totally natural! If you want to minimize the wrinkles you see, you can consider Botox for the outer edges of your eyes, however it’s important to understand that not every wrinkle will disappear when you smile.

Wrinkles around the eyes

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Dear sweetsince86,

  1. The combination of Botox or Dysport with Restylane under the eyes gives phenomenal results
  2. You may not need Restylane under the eyes, the Botox will at least take care of the wrinkles and make the eyes more open
  3. When you are ready, see a specialist who can go over all of your concerns

Best regards,

Nima Shemirani

Nima Shemirani, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 80 reviews

Crows Feet Correction

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The Restylane likely has had nice effect on the deficient zones of your lower lid orbit area.  The lining I see when you smile is basically the good old fashioned Crow's Feet that we all get.  The miracle drug Botox works well for these.  My recommendation is to now treat your Crow's Feet with Botox.  You will be fine.  My Best,  Dr C.

Treating wrinkles around the eyes

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There are several ways to address your concerns so you can keep smiling without worrying about your eyes.  Botox or Dysport would work great to reduce the lines you see around the sides of your eye and some of the bunching skin at the corner of your eye.  Botox works on the circular muscle around your eye to weaken the movement that makes these lines.  That way, when you smile you won't squeeze that area on the sides of your eyes as hard and the skin will appear smoother.  The effects of Botox typically last around 3-4 months.  

Restylane or Belotero are fillers that could add volume to the hollow area under eyes near your nose sometimes referred to as the "tear trough".  This is performed by a simple injection in the office.  Typically results will last between 6-9 months in most patients.

From your pictures, you also appear  to have a good amount of freckles and sun damage.  Its important to continue wearing sun protection to minimize development of wrinkles as you age.  Laser resurfacing may also be a good option for you down the line to improve your skin and treat the lines that around your eyes.  

Botox and Restylane eye treatments

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Thank you for posting appropriate pictures. You will have an excellent result using a neuromodulator (Botox, Dysport or Xeomin) below and corner of your eyes in addition to a filler (Restylane or Belotero) in the trough below your eyelids. Look for a board certified expert injector to perform this procedure for you. Best of luck. 

Botulinum toxin and filler around the eyes

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A combination of botulinum toxin and filler will help your eyes look more rested. If the wrinkles worsen with facial expression, botulinum toxin will help a great deal. Over time, if the underlying muscles are not relaxed, the wrinkles in the overlying skin become etched. Etched lines are very difficult to treat and best avoided. Therefore, botulinum toxin will help treat the current lines and also prevent them from getting worse over time. Fillers can help further soften the lines.

Ramona Behshad, MD
Saint Louis Dermatologic Surgeon

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.