Thick under eye folds when smiling - what can I do to correct this? (photos)

Question

They only appear when smiling but are very prominent. What’s the best way to treat this?

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.In your case I highly recommend you to get a lower eyelid blepharoplasty to get rid of the extra skin, that mostly appears when you smile.

Jeffrey Lisiecki, MD · Answer

This is the action of your orbicularis oculi muscle. It can be softened temporarily with botox. The more permanent fix is lower blepharoplasty.

Jason Emer, MD · Answer

The eye area needs significant combinations to get improvement. Lasers like erbium, co2, halo, profractional/contour, or Fraxel can all be used to build collagen long term. Plasma pen is a newer less invasive option but will take many treatments and require proper skincare. Plasma Pen is focused electrical plasma energy to tighten skin, producing small columns of energy just above the skin, allowing the skin to tighten to help improve wrinkles. This area will have 3-5 days of small “dots” that will then scab and peel, then the skin will tighter and brighter after. Numerous treatments are needed over lasers where only one or two give a bigger result, but more downtime. After plasma pen you NEED peels 2 weeks like later Cosmelan, enlighten or aerify, see emeragecosmetics (link). At home derma rolling should be started weekly even after plasma pen or lasers to further increase collagen, see emeragecosmetics AERIFY x anteagemd stem cell ampules. To properly heal you need light Stim red LED, EmerageSkin refit face, refit eye; AnteageMD serum, silagen silicone gel, jan Marini bioshield, EmerageSkin enzymatic polish, and EmerageSkin hyla b and AOX, and Sente dermal repair. Otherwise there is EXTREME risk of pigmentation issues and “dots” in the treatment area. at home peels like cosmelan, enlighten and aerify along with dermarolling (AERIFY emerageskin roller with Anteage MD ampules) should be started now regardless for antiaging, sun damage, and wrinkle prevention. 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 eyelid blepharoplasty with or without fat pad repositioning (if doing lower eyelid surgery) 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, lasers, microneedling/PRP, cosmelan peels, 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. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Nima Shemirani, MD · Answer

Hi @Diligent732017! You would be a great candidate for a lower lid blepharoplasty with fat transposition to fill your tear trough. This will reduce the bag in the lower lid and add volume to the tear trough. Best of luck, Dr. Nima!

C. Blake Perry, MD · Answer

You would benefit from a lower lid blepharoplasty with fat transposition to fill your tear trough. This would add volume to the tear trough and reduce the “bag”in the lower lid. You would also need either a skin pinch removal or laser to tighten the skin. Best to see an eyelid expert in your area.

Ahmad H. Ahmadi, MD · Answer

There is excess skin and protruding fat in the lower eyelids. A blepharoplasty to remove some of the excess skin and correct the protruding fat, either by removal, transposition, fat grafting, or septal reset, can improve the lower eyelids.  Best to see a board-certified plastic surgeon for an exam and recommendations.

Shana Kalaria, MD · Answer

There is a procedure called a pinch blepharoplasty which involves removing the excess skin of the lower eyelids using a small incision hidden under the lash line. This procedure can be done under local anesthesia. You would benefit from this procedure. Please see a board certified plastic surgeon for your procedure. Good luck!

Camille Cash, MD · Answer

From your photos it appears you are a candidate for a lower blepharoplasty.  This would address the excess skin that you are noticing when you smile.  During this procedure under eye hollow contours can also be corrected.  See a board certified plastic surgeon near you to learn more.

Darryl J. Blinski, MD · Answer

Great series posted photos demonstrating active lower eyelid wrinkling. Non surgery options are sessions of micro dosed Botox every 3 weeks for 3 sessions or until improvement seen or not seen. If not helpful, then lower lid blepharoplasty. Best t virtual with....

William Portuese, MD · Answer

The primary goal for lower eyelid surgery is to remove the fat bags creating the puffy look which is evident only in your third photograph. When there's excess skin at rest (not when smiling), then the excess skin can be removed with a pinch technique. In our practice, we close that incision with tissue glue.

Thick under eye folds when smiling - what can I do to correct this? (photos)

Answers (10)

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