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Options for Under Eye Bags Caused by Muscle Hypertrophy?

Hi, This has been a problem since I was a little girl, now I'm 40 and want to improve the appearance of my under eye bags, whether it is with surgery or fillers.

I look tired all the time and my bags just keep getting bigger as I age. I went to my consultation for blepharoplasty (Eyelid Surgery).

She told me there's nothing that can be done, because it's all muscle and not fat. Could I have hypertrophy? What can I do? I can't stand to look at myself or have others look at me. If there is surgery for this, what is it called?

Asked 30 months ago by Shellee in Texas

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Eye "Bag" Options When Caused by Muscle Hypertrophy

Hi Shellee, Unfortunately we are our own worst critics. You have a beautiful face, smile, and believe it or not ,eyes. Sorry that you feel uncomfortable with others looking at you, but as a facial cosmetic surgeon, I will give you my opinion...actually I already have above. If you were my patient I would treat you most conservatively, beginning with very low dose Botox placed just below your lower lash line. Let that settle for a few weeks and see how you like the result. Once the Botox has had more

Michael A. Persky, MD

Los Angeles Facial Plastic Surgeon

Botox may be worth a try for muscle thickness in the lower lid

The thickness that appears in the photo is not typically thought of as a "bag". Only an exam can confirm, but it appears to be hypertrophy or thicknening of the muscle that lives there. Botox may, over time, improve the appearance of thickness and achieve your goals. An experienced Botox provider can give you a more precise opinion after a consultation.

John E. Gross, MD

Los Angeles Plastic Surgeon

ASAPS ASPS

Muscle reduction versus muscle weakening

The fullness just below the lash line is generally muscle bulging and hypertrophy. The muscle tends to roll on top of the cartilage plate of the lower eye lid. The methods to deal with this have to do with reducing the volume of muscle with excision or weakening it with Botox. It would be helpful to see the movement of the muscle as you tightly close you eyes and see the muscle action. The muscle could be weakened with Botox. This has to be done with very small doses to not over do it at... more

Marcus L. Peterson, MD

Saint George Plastic Surgeon

ASAPS ASPS

Possible to perform muscle shaving but not recommended

What you describe is the thickness of your orbicularis muscle. This muscle acts like a 360 degree sling around the eye. It has multiple very important functions: Forcefull eye lid motion, blinking, lid position,tear pump mechanism etc. This is a natural bulge and not an eye bag and it is better not to try to change it. In very select cases, carefull shaving of the muscle by a plastic surgeon well versed in occuloplastic techniques could be done. I would still not recommend it except if you... more

Hisham Seify, MD, PhD

Los Angeles Plastic Surgeon

ASPS

Lower eyelid bags due to muscle hypertrophy

According to the picture that was presented, yes, indeed, there is a slight hypertrophy of the muscle on the lower lids. It is impossible to go in and remove this because it will leave you with a weakened and paralyzed lower lid and is not advisable to have anything done about it. There does not appear to be any fat pads present underneath the muscle. It does not appear that you are a candidate for a blepharoplasty.

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William Portuese, MD

Seattle Facial Plastic Surgeon

Your eyes are not the problem

In the photo, your eyes look great and I wouldn't do anything based on this photo. I would like to see a photo of your face when you are NOT smiling. Most likely, you have volume loss in your cheeks and under you eyes. This can make you look tired and gaunt even though you don't have any bags under your eyes. The best treatment for this is fat injection to the cheeks and lower eyelid depending on where you need it. This could truly brighten your eyes and whole face. The fillers are an... more

Parham Ganchi, MD

Wayne Plastic Surgeon

ASAPS ASPS

Lower Lid Muscle Hypertrophy

I think we all can appreciate the issue that you're having. However, it's not that the muscle is changing but the aging process is changing your lower lid/cheek junction. As we age the deep tissues of the face descend. This creates worsening of the nasolabial folds as well as a more pronounced lid/cheek junction. This junction occurs at the bony orbital rim. So you have a convexity with the pretarsal muscle (the bulging part) then a depression/concavity down to and just over the orbital... more

Christopher L. Hess, MD

Fairfax Plastic Surgeon

ASPS

Botox and filler.

Hi Shellee: would consider a little filler under your rim and some botox to decreasing the orbicularis contraction that is causing you to have a more significant orbital rim depression. Surgery a bit drastic for you slight problem. I prefer to use Radiesse under the muscle and just below the rim.

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Richard Gentile, MD

Cleveland Facial Plastic Surgeon

Lower eyelid shape

Dear Shellee, what you are describing and whag can be seen in the photo may not be the same. Muscle hypertrophy of the lower wywlid can be treated with a little Botox and if there is an underlying hollow- this can be corrected with micro fat grafting or placing Restylane on the deep layer in the hollow on the bone. With Warm Regards, Trevor M Born MD

Trevor M. Born, MD

Toronto Plastic Surgeon

ASAPS

You look wonderful, I would never make an incision on your eyelids

You are very pretty with lovely eyes and a young-looking face. I definately would not make an incision on your eyelid and try to reduce the orbicularis muscle--you would loose the natural beautiful look of your eyes. As you get older, if you do consider any procedure at least think about an open fat graft (NOT fat injection!) to plump or fill the depression beneath the bulging muscle. This can camouflage the depression beneatah the muscle and add volume to the area. This also can be done... more

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Brooke R. Seckel, MD

Boston Plastic Surgeon

ASAPS ASPS

Options for under eye bags caused by muscle hypertrophy?

Your doctor was correct in identifying this as a muscle problem. Some have suggested Botox, and others excision of muscle. I would try the Botox first to see if you like the effect. If you do like it and decide to go ahead with a blepharoplasty, make sure the surgeon excises ONLY muscle, and not skin. You have no skin excess, and skin resection might cause scleral show, where the whites of your eyes show under the cornea. When I look at your picture I see a pretty woman, as many others... more

Ricardo Rodriguez, MD

Baltimore Plastic Surgeon

ASPS

Muscle volume can be reduced

If your problem is due to muscle hypertrophy, then it can be corrected very nicely with lower Blepharoplasty surgery. The technique involves debulking the muscle mass along the width of the lower lid. This gives a very natural and long lasting result. I would seek a second opinion from a plastic surgeon who is familiar with the technique.

Robert M. Jensen, MD

Medford Plastic Surgeon

ASAPS ASPS

Lower eyelid muscle

The area of concern is due to the muscle contracting along the lower lid. I would not use Botox along this area, because it may lead to an ectropion( drooping lower lid). You are an attractive woman with normal anatomy..leave it alone.

Steven Wallach, MD

Manhattan Plastic Surgeon

ASAPS ASPS

Try Botox or Dysport

Dear Shellee, Find an experienced Botox injector. Ask for 1 unit of Botox in the roll under each eyelid. This might solve your problem without surgery. If your plastic surgeon is up on the latest treatments, 2.5 units of Dysport would also work. Dysport is nearly equivalent to Botox. Do be aware that this is a tricky use of Botox/Dysport. There are a few potential (albeit unlikely) risks. Lowering the lower eyelid margin (so that you see white beneath your green irises) Loosening the... more

Michael C. Pickart, MD

Ventura Plastic Surgeon

ASPS

The "bulge" under eyes is not the problem

Dear Shelee As other doctors have noted, that thing you see as a lower eyelid bag is your orbicularis oculi muscle which is vitally important for the function of your lower eyelid. Aesthetically, that roll of muscle is not your aesthetic issue. Your issue is the hollowness under this roll of muscle which is referred to as a tear trough hollow. Given your age and your aesthetic issues, the best approach for addressing this is to fill the under eye hollow with Restylane. The service can be... more

Kenneth D. Steinsapir, MD

Los Angeles Oculoplastic Surgeon

Treatment for under eye bags

You have a couple of options, pending an exam of course. The muscle can be conservatively trimmed just under the eyelash area. I have successfully performed this procedure in the past, and it is done with local anesthesia and twilight sedation. In some people a minimal Botox injection can minimize the bunching that you have in that area, but it is not a permanent correction.