How Under Eye Wrinkles That Appear When Smiling can be Helped with Non-Surgical Treatment

By: Amiya Prasad, M.D.

What is Recommended for Inner Corner Up Eyelids and the Puffy Bags That Form Under my Eyes That ONLY Show when I Smile? I had a facelift in 1995 and only remember I had a left droopy eyelid that was corrected and had some problem healing the lid. Often the inner corners look puffy or like extra skin folds and eyebrows don't look particularly symmetrical. My under eyes look great until I smile and then you see many bags form.

Is a full blepharoplasty recommended or what? My biggest problem is when I smile, I have eye bags. When I'm not smiling, my mouth looks mad. Thank you for your question. It is clear by your description how frustrated you are with the challenges of having bags under your eyes when you smile and that when you don't smile your mouth looks sad. You describe in your question that you had a facelift in 1995 and that you had a dropping eyelid that was treated and had issues when healing so I look at your photos and certainly there are some ongoing issues that can be a concern but I think you kind of need to look at the big picture a little bit. First of all, looking at your eyelids at rest, it appears from at least from one of the photos you submitted that there is some puffiness. Now it's not a lot of puffiness in the lower eyelid but there is some there so the non-verbal communication of puffiness especially when your face is at rest is that you are tired at your lacking energy that something at least to evaluate.

Now the dynamic activity of muscle actions when you smile, there are two aspects in smiling that certainly challenges people that come to us. First is the wrinkling that is related to the activity of the muscle called orbicularis oculi muscle. This is the muscle that surrounds the eye and is responsible for supporting the eyelid and it allows you to blink so although Botox can be very effective for those lines. The wrinkles that form under your eyes can be helped a little bit with this Neurotoxins such as Botox and Dysport but there is also another factor that I think you are also maybe somewhat aware of and maybe that is the recruitment of skin when your cheek moves up. I always tell my patients it's kind of like an accordion when you smile the just movement of the cheek upward will push skin against the eyelid and create wrinkles. Now, yes there is going to be difference between how to look when you are 40 years old to compare when you are 60 or 70 years old and a lot of this have to do with the skin quality and thinness of the skin but understand there is no way to completely eliminate those wrinkles but there are strategies to help improve the skin quality. I think that one of the things that many people do and the people who come to us, there are so many ways resonate with my own personality and that they are very exacting, very obsessive really look at details carefully. But unfortunately a lot of times when people look at details too carefully, they certainly lose the forest for the trees and I think that when people look in you and this has been proven in many psychology studies, we look at ourselves in details while other people look at the big picture.

So you're in position in where you're concerned about the wrinkles in your eyes and how you will be perceived so that when you smile, you see the wrinkles but certainly when you don't smile the mouth looking sad well think to yourself why do people think when they look at you and when your mouth is sad then they are going to think your sad. I wrote a book few years ago called The Fine Art of Looking Younger and there is certainly a strategy. Being a multi specialty surgeon, I have the opportunity to do a lot of things to people and literally be their beauty doctor for their lifetime.

How Under Eye Wrinkles That Appear When Smiling can be Helped with Non-Surgical Treatment

And so many of my patients who I have practiced with for 20 years, I have helped them at one stage at their eyes another stage with the jowls. Critical strategic solutions that are minimally invasive and that allow for a natural appearance has been my overall philosophy. And so I think considering to have maybe some fillers maybe to have some volume enhancement, something we do where we put Botox or Dysport in a muscle called the depressor anguli oris muscle to lift the lips or these things that can help the area around the mouth or as we refer to us the perioral area can help get that overall look to improve.

As far as the wrinkles under the eye that are concerned, when you reach a certain age the skin gets very thin especially if you lived in a sunny climate or you've been exposed to a lot of sun. What we typically do is we do something called platelet-rich plasma where we will inject from your own blood after we spin it down. A part of the blood called platelet-rich plasma and platelets are the cells that are responsible for healing when they have a cut and we have found and are able to help people with skin quality. Now a lot of times, what we will do, we won't just do it under the eyes but we will do it throughout the face to get this nice glow. You see platelet-rich plasma has this unique characteristic unlike other fillers where it has something called Vascular Endothelial Growth Factor.

Basically when you have an injury you need blood supply and so essentially where you are kind of mimicking the equivalent of an injury but doing it and a strategic way under the skin. Uniformly, our patients come back saying that the skin looks glowing and it looks really good and their friends compliment them on their skin. So you may want to take a step back and consider some of the strategies as a way to help you improve your overall appearance and maybe focus a little bit less on the specific issue of skin under the eyes be very careful that a plastic surgeon may say to you: "Let's remove some skin." Now particularly at your left lower eyelid, you appear to have a little bit of sagging or pulling which is almost like a what we called lid retraction so be very mindful not taking away of skin because skin that is recruited during dynamic activity will not be there when your face is at rest.

And people come to us all over the world with the condition called lower eyelid retraction because their plastic surgeon with the best intention try to remove skin to address their issue and at rest the eyelids pull down so just be mindful of that. So understanding that we are looking at skin quality, we are looking at some other residual puffiness under the eyes and the overall strategy to enhance the face as to focusing specific on the lower eyelids. So I hope that shed some light to your concern. I hope that was helpful and thank you for your question.

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