Puffiness Under Eyes that Only Appear When Smiling Do Not Need Cosmetic Treatment

Author: Amiya Prasad, M.D.

Thank you for your question. You’re 24-years-old, you’re a Filipino descent and you have submitted several photos that are very helpful and you describe in detail how you have some issues with dark circles under the eyes as well as the presence of bags under your eyes particularly when you smile. So you are looking for some guidance as to deal with this concern. Well I can certainly assist you.

I am a board I’m a board certified cosmetic surgeon and a fellowship trained oculofacial plastic and reconstructive surgeon practicing in Manhattan in Long Island. Under eye bags is something I have been helping people with everyday in my practice for 20 years. So I think that there is an opportunity for you to become more educated as to the definition of your concerns whether or not it’s appropriate to seek some type of solution. So when people come to us for under eye bags more commonly the bags are there constantly regardless of facial expression. And when that’s the case like when the face is relaxed and you see bags that are usually caused by something called lower eyelid fat prolapse. What that means that the fat that’s normally around the eyes pushes forward and creates this bulge of fat and it is routine for us to address this fat packet with local anesthesia, LITE™ sedation and most routinely we do a procedure called transconjunctival lower eyelid blepharoplasty. Now when someone like yourself presents to our practice and has this type of problem where they don’t have bags when their face is relaxed but do have what they perceived as bags when they are smiling, well most likely this is caused by the contraction of a muscle called the orbicularis oculi muscle.

Now this is a muscle that supports the eyelid. It is responsible for the position as well as for blinking. So when you smile, it’s like contracting a bicep muscle. The muscle bunches and the skin bunches with it and it results in what you perceived as a bag. Now when people have come to us with this concern and they say they really don’t like it. I’ve always shared with them the importance of this particular muscle at baseline for proper eye lid position and if this muscle were let’s say for example relaxed with Botox™ it is possible to get some improvement but in order to keep the balance where the muscle tone is still there to provide proper support, it may not be dramatic enough to justify the cost and the trouble of doing these procedures over and over but I think that the majority of our patients who I explained this to that at least feel that they understand why they have this type of ridge under their eyes. Now from my perspective as an artist, as a cosmetic surgeon I don’t find these types of issues to be aesthetically a problem. I think that it’s part of the look when someone smiles to have the bunching when that occurs and of course a smiling face is always an attractive face from my perspective.

So I think that you could consider experimenting with using some Botox™ or Dysport to see if that muscle tone can be improved but I think I’m always hesitant and more conservative when dealing with people who are younger like yourself and requesting some type of procedure where how practical is it for you to do this with your lifestyle and it is of course different when someone enters mid 30s and beyond but in your early to mid-20s, I think it might be a little bit of a challenge to justify the expense and the trouble but that’s a personal decision. As far as the pigment is concerned just for the completeness, it’s essentially genetic trait and since you are young I would not usually do for people who have dark under eye circles or hollows where I use something like a platelet-rich plasma (PRP) which is derived from your own blood as you need to stimulate your own skin and improve skin quality or combine that hyaluronic acid with platelet rich plasma to help with under eye hollows which you don’t have. So again with genetic issues as well as functional normal issue and in the context of being young, I’m really hesitant to suggest you pursue aggressive treatment. Certainly I think it is appropriate to meet with qualified experienced doctors but at least remember that whatever suggestions are made, you have to think of its sustainability.

Puffiness Under Eyes that Only Appear When Smiling Do Not Need Cosmetic Treatment

If you want to experiment and see what happens, I think drugs like Botox™ and Dysport are safe and can be worth just to satisfy the curiosity but otherwise, I just think that you would probably be better of waiting than to do anything for a few years. So I hope that was helpful. I wish you the best of luck and thank you for your question.

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

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…

By: Amiya Prasad, M.D.
Allergies to Hyaluronic Acid Fillers are Rare, but Other Factors Can Cause…

Thank you for your question. You submitted two photos and with those photos you state in the history that you underwent filler with hyaluronic acid filler placed with a cannula and…

By: Amiya Prasad, M.D.
Possible Causes of Lumps Long After Cosmetic Filler Application, and the…

Thank you for your question. You submitted 2 photos and you state in your question that you received Radiesse injections in the chin approximately 13 months prior. And you’re describing…

By: Amiya Prasad, M.D.
How Eye Bags can Worsen Since Filler Treatment, and a Definitive Puffiness…

Thank you for your question. You submitted several photos and you describe in detail in your question that you had Restylane placed in your tear trough in 2015 and that with time, the…

By: Amiya Prasad, M.D.
The Limitations of Dermal Fillers to Treat Puffy Eye Bags, and Fast Recovery…

Eye bag removal or filler? Hi, I am considering eye bag removal or filler for my under eye hollows. Please, could you look at my picture and tell me what you think I need doing to correct…

By: Amiya Prasad, M.D.