What is Recommended for Inner Corner Up Eyelids and the Puffy Bags That Form Under my Eyes That ONLY Show when I Smile? (photo)

Yes you have a small knuckle of fat in the medial left upper eyelid crease.  However, you have profound upper eyelid ptosis that is so severe in actually encroaches into your visual axis.  I would recommend consulting with oculoplastic surgeons regarding the upper eyelid ptosis to determine what you need.  Well done a brighter eyed look will transform your appearance.  While you could look on the ASOPRS website to find a well trained oculoplastic surgeon close to home, I recommend finding an aesthetically oriented surgeon.  You might need to travel in your State for this.  They can also address the lower eyelid issues at the same time.

The photos posted shown display upper eyelids with relatively high lid creases and a somewhat hollowed out look.  There may be a very small amount of skin excess, but the inner corner of the eyelid is an area that looks terrible when over-resected. The upper eyelid creases could potentially be lowered and the eyelid lifted surgically.  A filler such as Belotero or Restylane could be carefully used to address the hollowness.  The dynamic appearance of the lower eyelid skin could be addressed with Botox and/or fractionated Co2 laser resurfacing.  I do not see indications for surgery in the lower eyelids.

You may have a scant excess of upper lid skin in the inner corners of your upper lids, but over resection can cause problems with closure. For the crepiness in the lower lids, I like to use Botox. It does not look like you need additional lid surgery from the photos you provided. Keep smiling!

Looking at the photos you submitted, there appears to be some puffiness in your lower eyelids. It’s not a lot of puffiness but it must be evaluated to know what must have caused this. I also observed that you have some sagging and pulling down of your left lower eyelid which we call lower eyelid retraction. This is usually the case of some of my patients who have had previous eyelid surgeries wherein their surgeon removed too much skin resulting in the lower eyelids being pulled down.

There are two aspects in the dynamic activity of the muscle actions when someone smiles. One aspect is wrinkling related to the activity of the muscle called orbicularis oculi muscle. This is the muscle that surrounds the eye which is responsible for supporting the eyelid and allowing one to blink. The wrinkles that form under your eyes can be helped a little bit with neurotoxins such as Botox and Dysport. Another aspect is the recruitment of skin when your cheek moves up when the skin is pushed against the eyelid and causes wrinkles.

One must understand that there is a difference between how they looked when they were 40-years-old compared to how they look when they are 60 or 70 years old. I wrote a book few years ago called “The Fine Art of Looking Younger” where I explained that aging is caused by many factors, including changes in skin quality and thinning of skin as people get older. Unfortunately, many patients look too much at the details and forget about the big picture. There is no way to completely eliminate those wrinkles but there are strategies to help improve the skin quality.

I have been practicing for 20 years and have helped a lot of my patients over the course of time with problems with their eyes to their sagging of the jowls. Basically, I have become their lifetime beauty doctor. My overall philosophy has always been critical strategic solutions that are minimally invasive and allow for a natural appearance.

I suggest that you have some fillers such as Botox or Dysport in the depressor anguli oris muscle to have some volume enhancement. This will also lift the lips and can also help the area around the mouth to improve the overall appearance of the face. As far as the wrinkles under the eye that are concerned, we typically inject something called platelet-rich plasma. This is from your own blood that is spun down. Basically, the blood contains platelets that are involved in healing. Platelet-rich plasma has vascular endothelial growth factor that contributes to the healing process and helps with skin quality. Platelet-rich plasma is not only used in the eyes but also in other parts of the body such as the face to improve the skin texture, quality and overall appearance. I hope that was helpful to you, and thank you for your question.

Upper Eyelid Hollows Respond Well To Belotero Balance

Upper eyelid hollows respond well to the injection of contouring fillers, such as Belotero Balance. Belotero Balance, a hyaluronic acid based filler,has the advantage, due to certain unique aspects in the product's manufacture, to allow it to be injected even in thin areas around the eyes with little concern for the development of a bluish discoloration of the skin seen with other hyaluronic acid injectables that may occur as a result of light scattering. Although I prefer Belotero for this purpose, Restylane L and Juvederm UltraPlus XC have likewise been used successfully for this purpose, usually after dilution

In the hands of an experienced injector, the replacement of volume in this region fills out the hollowed area restoring more aesthetic proportions between the upper eyelid and the lower portion of the brow. If desired, a test injection of a small volume of salt solution may be used to give an approximate idea of what the final result might look like following actual treatment. Improving upper eyelid hollows with injectable volumizers seldom takes more than five minutes per side.

Botox (and Dysport and Xeomin) works well for the under eye crinkling that is accentuated by smiling.

Treating areas around the eyes should only be performed by physicians with considerable experience in injecting this location.

The posted photos DO NOT show "bags" but only wrinkled skin on animation.. Best to seek IN PERSON advise./

In regards to your upper eyelids, there is fullness in the medial corners, which is due to fat.  What makes the fullness more prominent is the hollowness in the rest of the upper eyelids/brows.  Options include filling the real hollow areas of the upper eyelids/brow to make more youthful appearance or take the remaining medial fat.