Botox or filler for eye bags when I smile? (Photo)

Dear sam07,Thank you for your question. Lower eyebags correction usually require a multi-modality approach. It is important to be cost effective with any treatment plan, but usually a combination of Botox and filler injected with a microcannula will address your concerns.Hope this helps,Nirmal R. Nathan, M.D.Certified, American Board of Plastic SurgeryMember, American Society of Plastic Surgeons

There are a number of ways to treat under eye wrinkles and fullness.  First, you can use Botox to help the appearance of the crows feet wrinkles along the sides of your eyes.  Then to fix the wrinkle closest to your nose, known as the tear trough, I would recommend a filler like Retylane.  However, for the best result, I would recommend a lower lid blepharoplasty to remove the fat under your eyes which is causing that fullness.  The surgery can be done in combination with the injection of a filler or even your own fat to help fully smooth out that area under your eyes.  Good luck!

Good question. It is a little bit difficult to tell from your photographs. Yes, you can use fillers for this type of thing. Botox would likely help the lines lateral to your eyes but not be of any benefit for the “eye bags,” but certain fillers can smooth this area out. It appears from your picture that you have some hollowness in your tear troughs. Typically, hyaluronic acid fillers work best in this area. There are several different products, but in our practice we gravitate toward using Restylane in this part of the face. Proper photographs and a proper consultation with a facial plastics surgeon is necessary. Good luck.

Dear sam07,
Thank you for your question. It is difficult to make an accurate assessment and recommendations based on photographs alone. I recommend you seek an in-person consultation with a facial plastic surgeon or plastic surgeon who can perform a thorough examination and discuss with you the best treatment options to meet your aesthetic goals. Botox or other neurotoxin is a great treatment modality for taking away or minimizing wrinkle lines due to dynamic muscle movement and can thus with a small dose treatment help improve fine wrinkles under the eyes and/or help open the eyes. It will not directly address improving the appearance of bags under the eyes. Depending on the nature of your issues, you may benefit from filler treatment or possibly surgery. 

Based upon the photos you submitted, I would recommend a transconjunctival lower blepharoplasty with laser resurfacing of the lower eyelid skin. The advantage of this approach is that it is a more permanent procedure as the puffiness appears to be protruding fat around your lower eyelids. This can be removed from behind the eyelid without a visible scar and the laser can be used to smooth the skin below the lashes as well. Alternatively, you can do filler which is temporary and does not remove the puffiness as it only helps with the transition between the lower eyelid and cheek area. I would see a facial plastic surgeon in your area.

A combination approach will give the most improvement. Fillers, lasers, and microneedling/PRP can improve under the eyes. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

There is no doubt that Botox for forehead and periorbital area (crow feet) will create nice improvement. However, lower eyelid bags and tear trough are best treated with lower blapharoplasty (transconjuctival). Fillers may help (Restylane) but it will not solve problem. Good luck.

The photos that are submitted are  inadequate to evaluate your condition. You may require a combination of procedures to achieve your lower eyelid goals.

Hi,I recommend a formal evaluation to determine is you are a good candidate for fillers or possibly lower eyelid surgery.Best,

Thank you for sharing your excellent question and photographs.  Nothing replaces an in-person but nonsurgical options will likely require both botox and dermal fillers to achieve the most noticeable improvement.  Botox can be used to help smooth your outer eye wrinkles, while fillers in your cheeks and underlies can help smooth the transition from your eye to your cheek.  Hope this helps.