Best solutions for puffiness/bags under eyes when smiling and thick skin on upper eye lids (35, F)? (Photo)

I am 35 and just recently noticed the appearance of puffiness/bags under my eyes only when I smile. Over the past few years, the skin on my upper eyelids has also become thicker/lower. I have included a picture of when I am and am not smiling. I have been researching options including upper eyelid surgery and possibly fat redistribution under my eyes. In your opinion, what would be the best solutions to eliminate these issues? Thank you!

Doctor Answers 4

Best solutions for puffiness/bags under eyes when smiling and thick skin on upper eye lids (35, F)?

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At this time you are not a very good surgical candidate. I might try creams with hydroquinones and Belotero Balance HA filler injections..//

Wow, your eyes look great!

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I would be oh so careful with what you talk yourself into because when you look as good as you do, there is a lot of room for harm and not very much room for help.  I think you would do great with little things like a micro droplet botox service and a little under eye Restylane.  Please be careful out there.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

You do not need a blepharoplasty at this point!

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You have minimal signs of aging in your eyelids, and you look more like an "after" picture for most people!  You could put a little botox into the muscle under the lashes if that roll of muscle bothers you when you smile.  You might also want to put a small amount of filler into your tear trough.     

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 31 reviews

Obicularis Oculi Muscle Hyertrophy

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Thank you for your question.  The photos you shared show evidence of Obicularis Oculi Muscle Hypertrophy or enlargement when you smile.  That's the roll under your lashes.  It can be treated with botox injections quite effectively.  Your case is a bit more difficult because your lower eyelid position is already lower than normal showing poor lid support (the white of your eyes are showing above your lower lid margin).  This could be an artifact of the photography so a physical examination would be needed to fully assess your situation.  Best wishes.

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