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

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

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!