When I Smile or Squint the Thin Skin Under my Eyes Puffs Up into Wrinkly Bags. What Are my Options? (photo)

I have thin skin and dark circles under my eyes. When I am expressionless, I have only faint lines which I don't mind, but when I smile or squint, I have puffy wrinkly bags under my eyes give me the appearance of being 10 years older than I am. One doctor recommended IPL. Is this a good treatment for my issue or are there better options to consider? I am not completely opposed to surgery, but would prefer to try a non-surgical method first. I would appreciate any recommendations .

Doctor Answers 7

BOTOX & Erbium Laser Skin Resurfacing to Remove Wrinkles

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Thanks for your question. Your problem is one of the more common concerns. Surgery is not warranted, because it would create more of an issue. Your problem is aging skin and squeezing of the muscle (Orbicularis Muscle) around your eyes. The simplest and most effective treatment is injecting Botox into the muscle in order to relax it. One week later, when you see less movement and fewer wrinkles, laser skin resurfacing can be performed to tighten the skin, smooth out lines and increase collagen production. The end result should be very pleasing to you. I hope you find this helpful. All the best.

Laser resurfacing

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I agree that if you are looking for a nonsurgical treatment of this laser is likely your best option. Also possibly a topical anti-inflammatory lotion. My partner is a dermatologist and we are very interested in treating this issue. We have found success with combination therapies. The best is to get an in person consultation because the skin thickness, muscle contribution and fat positions all have contributions to this issue. 

Hope this helps.

Best of luck,


Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 12 reviews

Eyelid wrinkles

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No surgery is needed since the eyelids look great at rest.  Botox is the best option when there is a prominent muscle and thin skin present .  

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I recommend non-surgical options to treat under eye wrinkles

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Thank you for your question. You're asking what to do about wrinkly skin that becomes very puffy when you smile. This is a very common issue in my practice, especially people with lighter skin. At half a millimeter, the eyelid skin is the thinnest skin in the body and it is easily affected by a lot of factors including sun exposure, smoking, and even hydration. Based on the photos you submitted, lines are visible when your face is relaxed, which we call static lines. When you smile, those wrinkles and lines become more accentuated, and those are referred to as dynamic lines.

As a specialist in cosmetic procedures in the eye and face area, I've seen mistakes where people have skin removed thinking there was excess skin. What happens is when they smile, the skin bunches up, and if their face is relaxed, their eyelids get pulled down. This condition is called lower eyelid retraction, but I wouldn't necessarily advise cosmetic eyelid surgery. I would recommend skin treatment to improve your skin's quality.

In my practice, I routinely use fractional C02 lasers and combine it with platelet-rich plasma. This is a cutting edge procedure where we draw blood and spin it to segregate the factors that are responsible for healing. This stimulates the body's own collagen and improves the skin texture. It also stimulates blood supply to make the skin healthier.

Years ago, I highly recommended combining treatments where we try to smooth out the skin with Botox or Dysport to reduce muscle activity that causes wrinkling during the skin's healing process. It doesn't totally eliminate it as long as you're moving and smiling, so you will still have some bunching, but it is a good way to prevent things from getting worse and improve your current situation. I hope that was helpful and thank you for your question.

Eye bag wrinkles when Smiling

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Thank you for sharing your photographs and question. Lower eyelid bags and wrinkles have a large variety of treatment options. While IPL may be an appropriate option, many plastic surgeons or dermatologist will also offer Botox Cosmetic to help soften these wrinkles. Botox Cosmetic is a quick office procedure that last several months to help smooth the skin. Only after a comprehensive evaluation can a cosmetic specialist help determine appropriate options for you.


Dr. Chaboki


Botox Treatment for Eyelid Wrinkles and Skin Bunching

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Because you seem satisfied with your eyelid appearance when you are not smiling or squinting, I recommend Botox for the crows feet on the outer part of the eyelid. Botox can also be used for hyperactive muscles under the eye to reduce muscle bunching if treating the crows feet alone is not sufficient.

Anita Mandal, MD
Palm Beach Facial Plastic Surgeon

When I Smile or Squint the Thin Skin Under my Eyes Puffs Up into Wrinkly Bags. What Are my Options?

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The wrinkles right at the corner of the eye are best treated with Botox. However, the wrinkles in the lower eyelid/ cheek area closer to the iris are best treated with surgery or laser treatments. Given that you want to avoid surgery, you are likely a very good candidate for laser eyelid resurfacing to tighten the skin in that area. I have found the fractional CO2 laser to be the safest and most effective laser for treatment of this area but there are other options available. I hope this information is helpful.

Stephen Weber MD, FACS

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.