Best options for getting rid of under eye bags when smiling? (photo)

Question

I have pretty large bags under my eyes when I smile and this is starting to really bother me. I've been doing Botox for my 11's and also in parts of my forehead but I'm wondering what will help my under eyes. I don't really have lines when I'm expressionless, it's only when I'm smiling which now makes me super self conscious. Will Botox help the bulge I'm noticing or should I be looking at under eye surgery or fillers? I attached a picture

Benjamin Caughlin, MD, FACS · Answer

This is a great question. So you are right in that botox helps to treat dynamic muscle movements. These bags are created by to things. # 1 your cheek elevates when you smile, this folds the excess skin in the area. # 2 the excess skin in that area is redundant with likely fluid accumulation.What can you do? Eyelid surgery would really be your best option.You can consider laser tightening of the lower lid but surgery to remove that skin is the best.In the mean time try a low sodium diet < 1500mg and try not to manipulate the lower lid. Often this is an issue with people who wear contacts or have allergies.Hope this helps.Best of luck,DrC

Anand D. Patel, MD · Answer

When the lower eyelid muscles become bulky and strong, they may bunch up beneath the eyelids when smiling. This is different from traditional lower eyelid bags caused by orbital fat. Botulinum injections may soften the appearance, but must be administered with caution as they may cause temporary lower eyelid dysfunction. During a lower eyelid blepharoplasty, greater improvements can be made by removing the excess muscle, while maintaining enough muscle for normal function.

Luis Suarez, MD · Answer

Hi! Thank you for your message and picture, you have a beautiful smile!
As you said, if the bags under your eyes just appear when you are smiling, it would be necessary to have an in-person consultation or virtual consultation with a certified doctor or plastic surgeon to review your characteristics when you are at ease. Lower eyelid with bag removal surgery could help you if the surgeon determines you are a good candidate by reviewing your case thoroughly.

Chad C. Zatezalo, MD · Answer

Thank you for the pic.  You will likely always have a mild bulge beneath the eyelid when smiling, but to soften the bulge there are several options.  First, you can add some filler to the tear trough.  In addition, a toxin injection into the bulge (hypertrophic orbicularis) will help.  You can have surgery for this, although, removing this muscle will likely lead to ocular dryness...
Good luck
Dr Z

Lawrence Scott Ennis, MD, FACS · Answer

There
are several key points to rejuvenating the middle-third of the face and making
this look more youthful.  A lower
blepharoplasty includes removal of the fat pads under the eye, tightening of
the muscle to hold the fat back, and elevation of the cheek pad, along with the
potential need to tighten the lower lid canthal ligament in some patients.  By doing this, the fat is removed from under
the eye and the puffiness under the eye is gone.  The critical part of this is elevating the
cheek pad in order to correct the hollowness and groove under the eye and
improve the nasolabial fold.
Unfortunately,
many surgeons do not elevate the malar fat pad/cheek pad with this
surgery.  Patients often are given the
option of cheek implants, fat grafting, or fillers in the lower lids.  My opinion is that these are often
unnecessary and the patient simply needs their own cheek pad lifted back into
position to give the eye a very youthful look. In your case, the photos do not give enough information but it looks like a lower bleph may be your best option. I recommend a consult with a board certified plastic surgeon to outline your best treatment. Good luck!

William Portuese, MD · Answer

When evaluating a patient for lower eyelid surgery, the decision is made at rest, not with animation. The primary goal for lower eyelid surgery is to remove  a conservative amount of fat from the inside of the eyelids to get rid of the puffy look. The secondary or minor goal is to pinch any excess skin that may be present in patients over 50 years of age through an incision at the lash line.

Brooke R. Seckel, MD, FACS (retired) · Answer

The fullness that you see underneath your eyelids were new smile  is caused by the contraction of the muscles of the lower eyelid and cannot be removed. These muscles are essential for normal lid position.

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