I have bags under eyes when I smile. Which would you recommend; fat grafting or fillers? (photos)

You will look freakish if you do not have these rolls under the eyes.  Don't let someone freeze these with botox.  This fullness is a normal part of your smiling face.  People you interact with are looking for these cue to let them know you mean you smile.

The eyes are the area that people look at 80% of the time during a conversation. So this is prime Real-estate. You are young so you want to be conservative. There are some temporary and simple things you can try to improve your look but I would be careful and make sure to not over do it at such a young age. 

 You are correct that a portion of your issue is volume loss but likely not significantly so yet. This takes time to evolve as we age. A portion sounds like it is orbicularis muscle activity from what you explain. Botox is a simple and temporary thing to try for the crows feet and could possibly be all you need. I also think you would benefit from laser treatments to the skin around the eye.  You have fair skin and there is likely an aspect of sun damage to the area. This is best treated with laser treatments in my hands. 

I am with you that a permanent and natural volumizer is the best. Fat is giving wonderful results of the periocular area and we are learning more and more about the benefits of fat. The skin is rejuvenated because along with the fat we transfer stem cells, cytokines and growth factors. This is part of the reason I like the combination of fat transfer with laser. Laser resurfaces the skin and then we rejuvenate it from beneath with the fat and stem cells.





Fills are an option but the results will be subtle and short lived. 





Hope this helps.





Best of luck,





DrC

My favorite option for crow's feet lines that are starting to show up is a neuromodulator such as Botox/Dysport/Xeomin.  The treatment will soften and probably erase those early lines.  Because the treatment only last 3 months, you have to keep up with the treatments to keep the results.  In terms of the under eye area, I'm not seeing much in terms of puffiness/bag or hollowness (may not be coming through as well in that lighting).  The best way to evaluate the area is in a consultation to examine the extent of hollowness.  For early aging changes under the eye, a filler is a great option.  The filler is temporary and when placed deep and conservatively by an experienced injector, the risk of irregularity or migration is very low.  Fillers are great options for patients who aren't interested in the downtime from surgery and who want an immediate result.  Most fillers in the US are FDA approved for 21 years and older.  For me, fillers tend to be more predictable than fat grafting and avoid the need for an additional procedure to harvest the fat - especially as the first option.  That being said - some surgeons have a lot of success with fat grafting.  I recommend more than one consultation with qualified surgeons to explore your options.  A lot depends on your exact examination and goals.       

This is a great question andthank you for the attached photos! Based only on what you mentioned and thephotos that you have attached, I see your eyes and smile appear well and normalfor your age. You need to keep in mind that there are some individuals whoexperience puffiness under the eyes when smiling. This is because theirorbicularis muscle is stronger compared to others, hence, it puffs a littleunder the eyes. This is not really because of fat prolapse.
However, if you probably see somethingthat I have not in your photos, I would highly recommend consulting a boardcertified plastic surgeon in person so that he or she can give a proper look atyour eye bags as well as the fine lines that you have mentioned. From there,your surgeon will be able to give you options and develop a plan that will suityou and your needs well. Your surgeon may offer you surgical and non-surgicaloptions or sometimes both. For surgical treatment, your surgeon may offerblepharoplasty. This procedure will remove or reposition the fat, should therebe fats in there, to eradicate under eye bags. A milder approach that providestemporary results would be through filler injections. Fillers can help concealthe under eye bags so that your face would look youthful. The results of fillerlook natural and such treatment offer little to no after effects. Nevertheless,since the result is temporary, you may need to repeat the procedure annually orevery two years to maintain the result. All the best!

I never like to consult based on photos but what your photos seem to show is very common.  Some people, when they smile, have a very strong orbicularis muscle the "bunches up" a bit under the eye.  It's not a fat pocket, although sometime it can be related to losing volume around the eyes as we age.  Firstly, there is nothing "wrong" with your smile and it doesn't age you, from what I can tell in the photos, but if it bothers you, seek out a consultation with a board certified oculoplastic surgeon and injection specialist.  This is usually treated very effectively and without significantly changing your smile with a few units of botox injected just under the skin over the overactive muscle.  While the treatment is not "permanent", you don't want permanent treatments on your face (trust me) because your face changes slightly every few months as you age and what looks good now, may not look good 5 years from now.   That said, this "off label" use of botox or one of the other neuromodulators has a long term effect because after a series of treatments (usually patients come in 3 times per year) the muscle in the area becomes weaker and atrophies and in my experience, patients need less and less treatment (or none at all as they age).  It is not a risk free treatment though because if too much botox is injected in this area, the eyelid can droop or retract down, and that is not an attractive look.  So it's essential to be treated by someone who has experience with these types of treatments.  DO NOT , in my opinion, have surgery to remove the muscle or thin it out.  It almost never looks natural and often causes all types of problems years down the line.I hope that helps and best of luck!