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How to Treat Bags Under Eyes When Smiling

How to Treat Bags Under Eyes When Smiling

model woman with bulging bags under eyes when smiling

I am frequently asked if the bags or bulges under the eyes that appear only when smiling may be corrected. I understand why people wish to treat this appearance, so let me explain what causes it.

It is first necessary to distinguish between the under eye bags I regularly treat in my practice. Allergies, sinus troubles, lack of sleep, exhaustion, or salt intake can all produce temporary puffiness or discolouration beneath the eyes, which can be treated to address the problem. 

What I address in my clinic are eye bags that are apparent all the time, whether your face is moving with a smile or laugh, or at rest, because they are caused by orbital fat that normally cushions the eyes, but has pushed forward resulting in these bulges.

Lower Eyelid Surgery

I address these under eye bags with lower eyelid surgery, also known as lower eyelid blepharoplasty, which involves contouring and removing the underlying fat.

Transconjunctival Blepharoplasty

My preferred surgical approach to treating eye bags is  , which involves sculpting and removing the fat that causes eye bags from behind the lower eyelid without making an outward incision. This behind-the-eyelid method appears perfectly natural, as if the bags never existed, with no signs of surgery,and preservation of the lower eyelid anatomic structure to ensure support is not compromised. This is in contrast to the more usually performed transcutaneous blepharoplasty, in which an incision is made in the lower eyelids to access the fat pockets, and eyelid skin is frequently excised to correct wrinkles.

The transcutaneous approach, particularly when eyelid skin is removed, is more prone to complications such as eyelid retraction, in which the lower eyelids are pulled down and appear rounded; ectropion, in which the lower eyelids evert outward and are exposed; and entropion, in which a skin shortage curls the lower eyelid edges inward, causing irritation.

lower blepharoplasty before and after on young female patient
orbicularis oculi muscle illustration

Cause of Bags Under Eyes When Smiling

The cause of the bulges under the eyes only when smiling is the muscle surrounding the eye called the orbicularis oculi. When smiling, the orbicularis oculi contracts, which can create a visible bulge in some people. The orbicularis oculi is an important part of eyelid function, as well as lower eyelid support. While the activity of the orbicularis oculi muscle can be reduced by a neurotoxin like Botox in some cases, it has to be carefully considered if treatment is worth it.

Bags Under Eyes When Smiling Treatment

While treatment can be done to reduce the activity of the orbicularis oculi to reduce the appearance of these bulges when smiling, it’s not a treatment I usually advise. Having bulges appear only when smiling or laughing is completely normal, and generally unnoticeable to others since everyone has the same issue to some extent. If someone opts for neurotoxin like Botox to reduce activity of the orbicularis oculi, only a small number of units are used. The improvement in appearance from treatment can be minimal, and even unnoticeable, so it may not be worth the effort to get treatment.

Botox for bags under eyes when smiling before and after
woman with under eye bags when smiling

Seeing a ridge or bulge form when smiling can actually be desirable by some cultures. In some Asian cultures, the small bulge at the lower eyelid is called the “love band”, with the larger accentuation when smiling a highly desirable trait. These cultures believe that the love band makes the face look more youthful and genteel, and actually go through a cosmetic procedure such as cosmetic filler treatment under the eyes to get it.

Eye bags that are always visible have a completely other cause called lower eyelid fat prolapse. As previously stated, I treat this issue with lower eyelid surgery, namely transconjunctival blepharoplasty, which involves no external incision and so preserves the orbicularis oculi muscle and other eyelid support components such as the skin.

Sometimes, people mistakenly think that a small bulge caused by the contraction of the orbicularis oculi muscle is residual fat that remained after lower surgery. While it is possible for residual fat to remain after lower eyelid surgery, an examination can confirm that it’s the muscle contraction. The orbicularis oculi is functionally important for eyelid closure and support, so the muscle, or any other part of the muscle, cannot be removed to relieve any perceived bulges.


The bulge under the eyes that only appears when smiling may not be worth the effort and money to treat, as the muscle has a limited response to neurotoxins like Botox, and lower eyelid surgery is neither appropriate nor safe for treating the muscle. Everyone has this appearance to some degree, therefore it’s perfectly natural, normal, and barely apparent to others. As humans, we have a tendency to be overly critical of our own appearance, as if we were our own worst critic, but this small issue, which is rarely evident even to ourselves, is unlikely to need treatment. I hope this information is helpful.

Botox for under eyes before and after treatment at Prasad Cosmetic Surgery

Eye Bag Removal Surgery Manhattan NYC and Long Island New, York

Dr. Amiya Prasad is a Board-certified cosmetic surgeon, and Fellowship-trained oculofacial plastic and reconstructive surgeon. As an oculofacial or oculoplastic surgeon, Dr. Prasad specializes in all types of surgical and non-surgical treatments for the eye area, from under eye bags, hooded eyelids, dark under eye circles, wrinkles, eyelid ptosis. To schedule a consultation, fill out the form below or call any of our offices: (212) 265-8877 for Manhattan, (516) 742-4636 for Garden City Long Island Office, or (703) 356-1336 or (703) 821-2683 for Vienna, Virginia.

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