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

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.

Bags under the lower eyelids are usually caused by displaced fat, redundant muscle, redundant skin, or sometimes even a prominent vascular plexus giving the aesthetics of lower lid bags or dark circles.
Early volume loss in your upper cheek and tear trough area can exacerbate even a small amount of genetic predisposition to having eye bags. There are numerous, good options to address this issue ranging from nonsurgical to surgical.
It is important to realize that it is displacement of fat, NOT excess fat that can cause lower lid bags. Old school blepharoplasty approach took skin and fat out of the lower lids by cutting right through the skin, which gave long term poor results with hollowed out lower lids and more potential for surgical complications. 
We know that we tend to lose fat as we age in our face, so taking more out as part of a surgical procedure may look good immediately, but it is a long term bad idea. Newer approaches to lower lid blepharoplasty do not cut through the skin and leave no external scars, this is called the transconjunctival approach. More important yet, the existing fat is repositioned instead of removed, giving much better long term results with a more conservative surgical technique that also has lower potential for complications. 
Nonsurgical options include strategically placed volume to replace early loss, which can have a dramatic impact on the appearance of eye bags and the junction between your eyelids and cheek. Volume can come in the form of fillers or as micro fat grafting. Laser resurfacing can also address these areas when skin changes are the prominent player. 
To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these “core four” cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.
Cameron Chesnut
#realself500 Physician

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,DrC

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

 

Great question you have here! The issueyou are experiencing is actually a usual concern by a number of individuals.You are actually in the right path of looking for a non-surgical approach toresolving the issue rather than trying invasive procedures on the get go.Surgery may not really do well in your case since it may give birth to otherissues of concern. To find the right non-surgical option for you, we first needto determine the factors that contribute to the wrinkly bags that you areexperiencing. One of the factors that we will consider is the think skin thatyou have mentioned, your aging skin, as well as the muscle around your eyescalled orbicularis muscle. With these factors identified, you may benefitundergoing Botox to relax your orbicularis muscle. This should minimize thepuffiness as well as reduce your wrinkles. After Botox, you can try laserresurfacing of the skin. This will help in tightening your skin therebysmoothening out the remaining fine lines. It can also stimulate collagenproduction for a more youthful and healthier skin. Hope this clarifieseverything!

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 .  

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.

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

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.