Fatty pouches under eye when smiling - only 24.

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

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!!