Age 20 - Large bags under my eyes when I smile. What can I do? (photos)

Question

I’m 20 years old and whenever I smile or laugh my eyes almost look like they’re closed from far away because of how much my skin bunches up underneath them. Why does this happen? What can I do to fix it?

Roni Prucz, MD · Answer

Excess skin, fat herniation from behind the eye, and insufficient fat at the lid cheek junction (i.e. the tear trough) are the main cause of large bags under the eyes. By performing a lower blepharoplasty with removal of excess skin, herniating fat, a canthopexy, and fat grafting if needed all of these issues can be addressed. I routinely perform this surgery with excellent results. You should discuss your care with a Board Certified Plastic Surgeon who should be able to provide more information. Thank you for your question.

Jonathan Kulbersh, MD · Answer

Hello, and thank you for providing photos along with your question. For wrinkles and bulges that appear when you do dynamic expressions, such as smiling, you may benefit from Botox injections. Specifically, jelly roll Botox is administered when the under-eye muscle “jelly roll” protrudes underneath the eye. Botox relaxes this muscle and creates a smoother and more rejuvenated appearance as the wrinkles shrink.

I recommend scheduling an in-person consultation with a reputable board-certified facial plastic surgeon or expert injector. They will be able to do a proper evaluation and customize the best procedure plan to achieve your desired results.

I recommend scheduling an in-person consultation with a reputable board-certified facial plastic surgeon or expert injector. They will be able to do a proper evaluation and customize the best procedure plan to achieve your desired results.

C. Blake Perry, MD · Answer

You need an in person consultation to help answer your question. Depending on how you look when you’re not smiling will dictate the best solution. Often lines and bags that form only when smiling can be improved with neuromodulators like botox. In other instances surgery is needed to remove and reposition fat from under the eyes. Best to see an eyelid expert.

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Nelson Lee Novick, MD · Answer

The kind of under-eye bulging accentuated by smiling is often related to hyperactivity and hypertrophy of the muscles directly under the eyes. If this is indeed so here, then the use of a couple of microdroplets of Botox place appropriately into the belly of the muscles below the eyes can help to diminish the bulges seen with smiling. Make sure to consult with an experienced, board certified cosmetic dermatologist and best of luck.

Jeffrey S. Yager, MD · Answer

Around the eyes there is a circular muscle to help you squeeze it closed tightly. In some cases, there is too much muscle, and on smiling, it stacks up on itself and forms what we call a jelly roll. This is different than the fat pads that you can see with aging. There is a procedure to carefully address this issue.