Options for Muscle Loss Under Eyes?

Hello, i am 24 i feel like i have muscle loss under the eyes..it's very hollow looking. no one in my family has this problem.my skin on face is very dehydrated and constantly feel like its pulling down. it all started 5 months after i got off accutane. please help.

Doctor Answers (6)

Loss of volume under the eyes

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It is unlikely you have muscle loss underneath the eyelids.  When the eyes become more prominent it is important to be evaluated for possible thyroid conditions.  The fat pads and bags underneath the lower lids are best treated with a transconjunctival approach.  Accutane usually has no effect on the lower eyelid muscles.  


Seattle Facial Plastic Surgeon
5.0 out of 5 stars 55 reviews

It is not the muscle loss, but droopy midcheek

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when the midcheek travels to south, it no longer covers the orbital rim region, and causes tear trough deformity, or hollow look. The best think is subperiosteal midcheek lift with canthopexy. you can read about MAG-5 procedure, designed by Dr. Flowers.

Adil Ceydeli, MD
Panama City Plastic Surgeon
5.0 out of 5 stars 44 reviews

Treatment of tear troughs

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Your posted photo shows what appears to be lack of bone support of the lower eyelids with a visible tear trough and darkening of the lower eyelids from a shadow created by the way the light falls in this photo. There is no visible muscle loss in this photo. From a single one angle view photo one cannot say exactly what your best option is. I suspect you need filler injections, fat grafting, an implant or some combination of these to correct the issue. If you have any allergic issues these need to be addressed first.

Checked to see if you have a negative vector of bone support as described in the referenced webpage.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

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Under eye volume loss

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Your picture shows prominent tear trough grooves and lack of volume in the lower eyelid. I don't think there was an actual loss of volume since you are too young for that; most likely this is your natural anatomy.  One of the side effects of Accutane treatment is thinning of the skin and subcutaneous tissues -- this could have exacerbated the problem.  What you need is volume replacement in the lower eyelid- midface area, which can be successfully done in the office settings with the use of a filler (Juvederm, Restylane, etc). As far as skin care is concerned - a moisturizing skin regiment should effectively correct skin dryness and tightness symptoms. An evaluation by a good aesthetician/ skin care specialist may also be useful to help you select a skin care product that would help the best.

Alexander Ovchinsky, MD
New York Facial Plastic Surgeon
4.5 out of 5 stars 11 reviews

There is no bone loss here.

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You don't need a "medical grade skin care program," that is just a way of keeping patients close to surgeons until they break down and have a surgery.  Not that there is anything inherently wrong with skin care but really all you need is a good moisturizer and possibly an under eye concealer.

Your issue is lack of bone projection at the orbital rim which brings out the appearance of the under eye circle.  The best option for a 24 year old is to start with the under eye concealer.  It will help.  However, it is likely that you will benefit from an under eye filler like Restylane for the under eye circle.  With the right volume, the service is likely to last a year or more and is done without surgery as a very comfortable office visit.  It is essential that you see an experienced injector physician.  Generally this will be a physician in the core specialties of plastic surgery, oculoplastic surgery, dermatology, or facial plastic surgery.  Please do not let a nurse do this treatment.  

Regarding fat transfer for this area, please don't get talked into this.  This treatment should be regarded as experimental with far too high a rate of complications.  There can be certain individuals where it can be the recommend approach for various reasons.  However the immediate under eye circle area is very thin and does not hide grafted fat well.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 16 reviews

Under Eye Tear Trough Hollowness

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Pleaseeehelp, you are not alone.  The under eye hollowness is an area of concern for many people.  First, I would recommend you start a good medical grade skin care regimen with active ingredients.  Most plastic surgeon offices carry medical grade products that are geared towards getting you results.   While it would be important to see your entire face to better assess this area and achieve balance, the undereye hollowness in the tear trough area can be addressed by either fillers (such as restylane) or fat grafting.  

Kimberly Lee, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 8 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.