Fatty pouches under eye when smiling - only 24.

Question

When I smile I get these fat pouches under my eye that makes me look older and are too big for my face. Lines are also present. Is there any solutions to fix this. Temporary and permanent?

Hooman Khorasani, MD · Answer

What you are refering to is your orbicularis muscle which is a bit more prominent in your case. This is part of normal anatomy and should not be removed. You may try to use small amount of Botox/Dysport to relax the muscle and therefore the skin folds that form on top of it. . However, please note that changing the orbicularis tone with Botox/Dysport  will also slightly change the shape of your eye. You may also try to use a resurfacing laser to treat skin texture ( in our case if would be a phrophylatic measure as your lines do do not seem that bad).

Stephen H. Fink, DO, FAOCO · Answer

The eye region is dynamic and complex. It would be helpful to see the eyelids when you are not smiling. From the photo provided, it appears to be a strong muscle contracting  with a groove beneath it. There are probably some non surgical options could be considered to help but a careful in person evaluation would be necessary with a trusted surgeon who can offer different options. 
Best to you,
Dr. Fink

Sanjay "Jay" Keni, MD · Answer

Hello,
I suggest you start with Botox.  It will prevent the muscle under the eye from contracting, thereby minimizing the appearance of the lines and puffiness when smiling.
Go for an in-person consultation with a trusted oculoplastic surgeon to see if you'd be a candidate for the lower eyelid surgery (blepharoplasty).
Best wishes,
Dr. Jay

Mark K. Markarian, MD, MSPH, FACS · Answer

Hello and thank you for your photograph.
Although you would best be served with an in-person consultation by a board certified plastic surgeon, judging from your photograph, the short answer is Botox + lower eyelid surgery (Blepharoplasty).
Long answer -- It appears you have an overactive orbicularis oculi muscle, the sphincter type muscle around the eye, that is bunching up the skin.  Careful relaxation of this muscle with Botox can help.  You can simulate this with local anesthetic at first that only lasts a few hours to see if you have the result you like that botox would achieve.  I also suspect that you have some fat pushing out at your lower eyelids that can benefit from surgical removal aka lower Blepharoplasty.  A photograph when you're not smiling would better allow me to assess the fullness of your lower eyelids at rest i.e. without the activation of the orbicularis (sphincter) muscle affecting the appearance.  If you do have fullness at rest, and undergo a lower Blepharoplasty, you have to be very careful at removing the fat, because too much fat removal can create a sunken appearance of your lower eyelid and compromise the lower eyelid-cheek junction and create an undesirable stepoff.

Your next step is to seek a
consultation with a board certified aesthetic plastic surgeon who addresses all
your concerns and discusses the Blepharoplasty details including the risks and
benefits of the procedure, recovery time, and post-operative course. 
Also, be sure to see plenty of before-and-after pictures in real women, and not
just computer-generated images, who have a similar lower eyelid appearance to yours, and preferably at different time
frames (3 weeks out, 3 months out, etc) to more accurately predict your own surgical course and outcome.  And lastly, I think the most important component of the
consultation is to establish a good connection with your plastic surgeon.  If you don’t feel you have a good connection
with your plastic surgeon after your consultation, he/she may not be the best
surgeon for you.For more information on Blepharoplasty, please refer to the link below.

Good luck.

Mark K Markarian, MD, MSPH

Harvard-trained Board Certified Aesthetic Plastic Surgeon

Janet Turkle, MD · Answer

It looks like the fullness might be due to contraction of the orbicularis oculi muscle.  This is the muscle that surrounds the eye and contracts when we squint or smile.  This contributes to crow's feet and the "jelly roll" under the eye.  A small amount of Botox administered by a well qualified injector can often relax the muscle and reduce the appearance of fullness when smiling.  A good eye cream can help to reduce the appearance of fine lines.  Daily protection of your skin with a good sunscreen also is helpful to protect your skin from premature aging.  Good luck!!

Brett S. Kotlus, MD, MS, FACS · Answer

The under-eye puffiness you are seeing when you smile is a combination of under-eye fat pads and your eye closing muscle called the orbicularis oculus. When the sphincter muscle contracts it creates a roll. Botox or Dysport can reduce the size of the muscle bunching while blepharoplasty surgery can reduce the fat pad size.

Edwin F. Williams, III, MD · Answer

Hello and thank you for your inquiry! There are definitely ways to address the puffiness under the eyes, one way being surgery to remove some of the fat. Whether from genetics or aging, some people are prone to developing these fat pockets. I'd recommend consultation with a Facial Plastic and Reconstructive Surgeon to discuss your options. Hope this helps!

Ahmed Ali-Khan, FRCS (Plast) · Answer

Hi thank you for your question. Those are not abnormal pouches. When you smile the muscles of your cheek contract (lifting the facial tissue upwards) and your orbicularis muscles around the eye are also contracting (causing the pouches). If there are lines, you might find Botox helps a little; but I would avoid surgery, such as blepharoplasty, for now given your age. Once you have surgery, gravity and time will bring these appearances back anyway, and its likely more surgery will be required / requested in the future so I generally suggest leaving it for as long as you feel able to do so.I suggest you visit a board certified plastic surgeon for an examination and advice.Best wishes.

William B. Rosenblatt, MD · Answer

Those are not fatty pouches. They are muscular ridges that you get when smiling. Perhaps botox will lessen them but there is no way to prevent them from forming when you smile. The fat that is removed with a blepharoplasty are there when your eyes are at rest and not emoting.

Fatty pouches under eye when smiling - only 24.

Answers (9)

More Eyelid Surgery Questions

WE SEND PRETTY
EMAILS

Answers (9)

More Eyelid Surgery Questions

What procedures are recommended for undereye lid bulges that occur only when smiling? (photos)

Would epicanthoplasty help me? (photos)

Are these malar bags? If so, what is the best permanent treatment to resolve the issue? (Photo)

7.5 weeks post transconjunctival lower blepharoplasty. Some days I love my result, other days I feel very swollen. Option?

Golf competition 6 days after blepharoplasty? How soon can I golf and/or should I withdraw from the competitions?

Is epicanthoplasty a good option for me? (Photo)

WE SEND PRETTY EMAILS

WE SEND PRETTY
EMAILS