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Woman: What can I do to improve my puffy eyes and wrinkles? I'm only 22. I'm 22 and I always look very tired and I get severe lines when I smile. My eye bags are puffy and look like I didn't sleep well. A doctor suggested 10 units of Botox under the eyes, but won't that make the bags even more prominent?

Dr. Amiya Prasad: Thank you for your question. You're 22 years old and you submitted two very good photos -- one with the eye at rest and one with activity where you're demonstrating that there are lines that you described as severe. By your question, you have mentioned that you saw a doctor who suggested 10 units of Botox and you're asking a very appropriate question that, "Will that relaxation result in increasing the prominence of the bags?"

Before we discus therapeutic options, let's just first define the issues that you're dealing with and what they are. Let's begin with the puffy bags. Puffy bags as they appear in the photos are most likely due to something called lower eyelid fat prolapse. Lower eyelid fat prolapse tends to be a genetic trait and although in many cases increases with aging. Certainly in a 22-year-old, it's not age-related. It's usually genetics. We've had patients in our practice as young as 14 years old who had tremendous bags and I've done surgery to help them. In your situation if you're puffiness is something that is constant and persistent, then most likely a definitive surgical procedure will be the solution to your issue.

I always tell patients who come in who have puffiness intermittently -- in other words, they have good days and not so good days -- I always tell them that if you have more not so good days, then most likely that puffiness is persisting and has pushed forward enough that you are ready to have a procedure. Unfortunately a lot of people try to camouflage bags like this beyond its certain threshold with fillers and they get themselves in all kinds of problems. Understanding that what you have is called lower eyelid fat prolapse and that you can observe how much they are prominent and how much they dominate the appearance of your face before you're ready to move forward with what I would suggest as a more definitive solution of lower eyelid blepharoplasty.

As far as the question about the wrinkles and the use of Botox, I can completely understand your hesitation. In my practice, I'm very hesitant to start people in their early 20s on Botox, Dysport or any of the other neuro toxins because we want to first look at what is causing the lines to be this significant. When you're younger your skin is as thick as it ever will be and the factors that I always ask about include that could accelerate aging are basically two significant ones. One is sun exposure. If you're spending a lot of time in the sun or you're using tanning beds and things like that, it is highly likely you are photo aging your skin and you're impacting on the quality of the skin. The quality meaning the thickness. Aging causes skin to become thinner. You lose collagen. You lose blood supply. It's just the quality diminishes. That's why we refer to sun exposure as photo aging.

The other factor I always ask about is smoking. I think there are few things that can be as damaging to the body, your health, and to your skin as smoking. Smoking generates carbon monoxide which literally chokes the oxygen away from your skin. It generates free radicals which damage the skin, besides doing horrible things to your lungs and to your blood vessels. It is often reflected in your skin. Very often and being in practice for 20 years graduating medical school in 1988, I can tell you that I can tell you that I can literally look at a person and know that they are smoker because of that certain quality of their skin. There's almost a grayish quality. If you are smoking or if you are spending a lot of time under the sun, it is recommended that you diminish the amount exposure, wear a sunblock, and of course stop smoking altogether.

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The Genetic Causes of Under Eye Bags in Young People

Dr. Amiya Prasad talks about the genetic causes of eye bags in younger patients, and how to treat premature wrinkles around the eyes.