Do I Need Surgery for This Type of Eyebags? (Photos)

All my life I've had these eyebags that are almost non-existent when I do not smile/squint. They are dark under my eyes, but that is not a big problem since I can just put on concealer. I was just wondering if these "smile-only" bags are caused by hollowness, fat or muscle. What procedures should I get? (Preferably non-invasive, unless necessary). * Photos included

Doctor Answers 3

Do I Need Surgery for This Type of Eyebags?

No, absolutely not.  These are not eye bags, of the lower eyelid but rather the normal shape of the lower eyelid muscles themselves.

Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 25 reviews

Lower Eyelid Bags when Smiling

Hi blueowl124,

Thank you for your question.

Lower eyelid bags are commonly due to fat, skin, and muscle to varying degrees in each person. Eyelid bags may also be due to medical conditions, such as thyroid or allergies. Eyelid bags on smiling suggests possible muscle as main component to the bag. Options may possibly include conservative use of Botox or facial fillers. These are nonsurgical cosmetic options to improve the eye area & rejuvenate the face.

However, only after a comprehensive evaluation can a specialist help determine appropriate options for you. Best of luck.

Dr. Chaboki


Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 85 reviews

Lower Eyelid Bags vs. Muscle Hypertrophy

Judging from the position of your lower eyelid bulges (submitted photos) as well as your description of their appearance only during smiling, you are noticing your lower eyelid muscles (orbicularis oculi) in action. Their prominence, however, seems exaggerated by the presence of visible surface depressions (tear troughs) just beneath your bulges and in proximity to your nasofacial grooves (they're even present when not smiling).

Surgery would not provide a good solution to your problem.

If anything is to be done for you, injection of a conservative amount of "filler" into the area of your tear troughs might be a consideration. It would certainly help eliminate your visible "tear trough" when not smiling, as well as reduce the disparity between your muscle bulges and adjacent tear troughs during smiling.

Although your photos have been cropped (for sake of privacy), it appears that the front surface or your face is also somewhat flat and deficient of natural cheek fullness. This raises the consideration of "filler" to that area as well. In the end, if non-surgical artificial filler is successfully tried, a surgical fat transfer may be the best long term solution.

Charles Gruenwald, MD (retired)
Baton Rouge Plastic Surgeon
5.0 out of 5 stars 11 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.