I develop very noticeable bags under my eyes when I smile or laugh. What's the most cost and time effective option? (Photo)

 If you are looking for purely cost effective treatment with no downtime it is worth a trial of botox alone. This can make a significant difference. It is cheap. It treats the contraction of the orbicularis muscle that leads to some of the wrinkles.  It is hard to be both cost effective and results effective. The most effective treatment for this in my hands is lower lid blepharoplasty, fat transfer and laser resurfacing. This combination of treatments treats the aging process involved. We lose volume as we age and the skin becomes more laxed. So you need to treat both aspects to get he best results.Hope this helps.Best of luck,DrC

What you are seeing when you smile is the muscle that runs under the lash line called the orbicularis muscle.  This muscle is what helps us blink.  In some people this muscle can be pretty big and sort of pops out when you smile.  A little botox placed into the muscle will help with this.  If you have a lower lid surgery done at some point the muscle can be trimmed - but not much or you may have issues with blinking and dry eye.  You also are pretty hollow in the lower lid - so some filler or fat there would help to mask the big orbicularis muscle.    

Thank you for your question.  Yours is a challenging condition to treat.  I would recommend a combination of botulinum toxin and HA filler (probably Belotero) for best results.  Surgery may be an option but that could only be determined by examination in person.  I would find a highly experienced surgeon who is familiar with both surgical and nonsurgical alternatives.  Best of luck.

Most expert
experienced artistic plastic surgeons have a variety of procedures, both
non-surgical and surgical, at their disposal to produce excellent cosmetic
results in the appropriately selected patient: neurotoxins like Botox or Dysport, temporary fillers, longer lasting micro-fat
grafts,  blepharoplasties, or combinations of the . There is no one best procedure. Each has benefits
and drawbacks and depends on desired outcome and individual anatomy.


Following the advice of anyone who would presume to tell you what to do without
seeing photos and without taking a full medical history, examining you,
feeling and assessing your tissue tone, discussing your desired outcome and
fully informing you about the pros and cons of each option would not be in your
best interest. Find a plastic surgeon that you are comfortable with and one
that you trust and listen to his or her advice. The surgeon should be certified
by the American Board of Plastic Surgery and ideally a member of the American
Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns
with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California