How Bulging Under the Eyes When Smiling may be Mistaken for Eye Bags

Thank you for your question. You submitted 2 photos. One of yourself and your mother and you state
that you are dealing with under eye bags that are genetically caused and you are looking
for a non-surgical solution to prevent your under eye area from looking like your mother’s
and you submitted 2 very good photos to help illustrate your concern. So certainly, I can give you some guidance
about the issues related to under eye bags. A little bit of background, I’m a Board-certified
cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long
Island for over 20 years and helping people with the aesthetics around their eyes is a
big part of what I do in my day to day practice. So, when I look at the photos you submitted,
I have to at least break down a little bit of what you are describing as under eye bags. So where I typically look when someone questions
me about having under eye bags is usually in an area that’s above the bone structure
or the rim where the eyes would look puffy and have large pockets which are typically
referred to as lower eyelid fat prolapse. In your situation, the photo you submitted
of your mother, I don’t see those things. What I believe you are probably referring
to is actually the area right below the eyelid margin where the eyelid skin appears to bulge
a little bit especially when you smile and very often people do come in and refer to
that area as under eye bags. The differentiation between this area for
you and your mother is that for your mother, it appears to be a little bit more prominent
and you see a few more lines. So in terms of management in this area, it
is very important to first understand what the basis for this concern is. Well, if it’s when you are smiling or even
when, baseline, not smiling, there is a little bit of a ridge there. That ridge represents a muscle called orbicularis
oculi muscle and this is a muscle that is important for the support of the lower eyelid. In general, this is not something that really
responds well to most non-surgical options and the definitive one or the most common
or popular one being an injection of a neurotoxin like Botox® or Dysport®. What that’s doing is to relax the muscle
slightly so that the muscle doesn’t bunch. Basically, when you smile, the orbicularis
oculi muscle contracts and when it contracts, it causes a ridge to form. So it is possible to put something like micro
Botox® or very small number of units of Botox® in your mother’s situation more than in
yours. Now, there is also an opportunity sometimes
to at least explore the area below called the tear trough. And in this tear trough area, there may be
a little bit of contrast that we are not appreciating with the photos you submitted where it may
look relatively hollow compared to the area just above it which might have a slight degree
of puffiness. Now this tear trough area is a relative hollow
that can be addressed with the use of fillers such as Restylane or Juvederm or basically
hyaluronic acid filler that can fill this area and we often combine that with something
called platelet-rich plasma (PRP). Platelet-rich plasma (PRP) is derived from
your own blood and consists of a concentration of the wound healing and growth factors that
are necessary when you have an injury or a wound. So what we are basically doing is we are trying
to improve the tissue quality as well as the skin quality to help stimulate collagen, blood
supply and overall fill this area. Now, this solution would probably be more
appropriate for your mother than for yourself. I realize that you are trying to do everything
you can to try and prevent the aging process to be as significant for you but unfortunately,
there isn’t always so much that you can do. Now it doesn’t mean that there are things
you can’t do to take action but it doesn’t necessarily mean procedures. What I am referring to is healthy lifestyle,
avoiding excess sun exposure, eating a good diet, getting enough sleep, minimizing stressors. But otherwise, the genetics of aging, there
is an opportunity, maybe when you are a little bit older, to do things such as platelet-rich
plasma(PRP) and fillers to try to minimize some of the signs of aging. However, I think it’s a little bit early
for you to do anything that is more invasive based on the photo you submitted. Now if there is a level of dimensionality
that is not being appreciated, certainly it is always valuable and beneficial to at least
meet with a doctor who can guide you and your mother about options. It is not unusual for me in my practice to
take care of people in several generations because of this genetic tendency to have these
types of issues but at the same time, it is also the role of your physician to guide you
when to do something and what to do as what not to do. So meet with doctors who you feel comfortable
with. Learn about your options, understand the distinction,
the anatomic issues as well as the strategies and then figure out what is worth pursuing
and what is worth deferring until later. So I hope that was helpful, I wish you the
best of luck and thank you for your question.


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