what can I do about the bags under my eyes that only appear when smiling
I'm often asked about the area just below the eyelashes
where a prominent ridge appears when you smile the patients often refer to this area as a bag
or as a bulge and they want to do something about it I'll discuss how I help my patients understand
what causes this appearance to occur and what i do to help them I'm Dr Amiya Prasad I'm a
diplomate of the American Board of Cosmetic Surgery and a Fellowship-trained oculofacial
plastic and reconstructive surgeon I specialize in all types of surgical and non-surgical treatments
for the eye area such as treating under eye bags hooded eyelids dark under eye circles wrinkles
eyelid ptosis so let's begin by distinguishing between the puffy under eye bags which are there
when you're not smiling and the bulge or ridge that appears more prominently when you smile
eye bags that are visible all the time are caused by fat pockets directly under the eyes that have
displaced forward creating these bulges also referred to as herniated fat
in my practice I treat these under eye bags with the procedure called a lower eyelid blepharoplasty
there are different ways to perform lower eyelid blepharoplasty so I'll discuss the conventional
approach and then my preferred approach which has been you know very successful for for my patients
the more conventional approach to blepharoplasty is to make an incision below the eyelashes and
separate the skin and muscle layers in order to reach the fat pockets this is called a
transcutaneous or through the skin blepharoplasty the transcutaneous approach typically includes
removal of skin to address wrinkles as oftentimes associated with complications
such as eyelid retraction and ectropion which are conditions where the eyelid margin is no longer in
its original natural position causing the eyes to be more exposed and consequently irritated
many people also find that after the surgery their natural eye shape is no longer the same as it was
before they underwent the procedure I often hear people who've experienced this say to me
they don't recognize themselves because the change in their eye shape for most of my patients with
under eye bags i perform a specialized technique called transconjunctival blepharoplasty this means
that I reduce the herniated fat from the inside of the eyelets avoiding the external incision
and reducing the risks of problems associated with conventional transcutaneous blepharoplasty
in order to address fine lines and wrinkles I typically perform fractional co2 laser or erbium
laser combined with PRP or platelet-rich plasma my patients retain the natural shape of their eyes
thereby preserving their unique character and just looking as if they would have if they never had
under eye bags now ridges under the eyes that appear when smiling is caused by a muscle
supporting the eye called the orbicularis oculi when you smile the orbicularis oculi
muscle contracts which can create a visible prominence below the eyelashes in some people
the orbicularis oculi muscle plays an important role in eyelid function such as in blinking
and lower eyelid support aesthetically speaking a genuine smile is not only expressed with your lips
and teeth but also with your eyes which tends to become smaller from the muscle contraction
interestingly in some Asian cultures the appearance of this ridge in the lower eyelid
is considered desirable and there are actually procedures using fillers and implants to create
what is called a love band in order to have this ridge be present all the time even when you're
not smiling as far as what I do for people who want to reduce their lower eyelid ridge
I use a botulinum toxin such as Botox, Juveau or Dysport to reduce the muscle activity in this area
this means that the degree of muscle contraction is diminished thereby reducing the prominence
of the the ridge anecdotally I've had patients who had prominent muscles at rest which were
more prominent when the muscles were contracting with precise dosing and placement of neurotoxin
they had improvement in their appearance both at rest and with smiling so there are under eye bags
caused by prolapsed fat and under eye ridge which looks somewhat like an under eye bag that's caused
by muscle activity that occurs with smiling since both of these issues are managed differently
you can now make a more informed decision when you're ready to have a consultation
i hope you found this information helpful thank you for your question