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

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.

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.