Treatment for under eye bags caused by muscle hypertrophy and excess skin? (Photo)

Question

I'm a 28 year old woman and have always had these bags and excess skin under my eyes for as long as I can remember. It's kind of a genetic thing as some of my siblings have it too. I really hate it and want to get it fixed. I thought that it was just excess skin below my eyes, but I saw one plastic surgeon who said it was caused from muscle hypertrophy. I am looking for opinions on what exactly it is and how I can get it fixed. Please help. (I posted 4 pictures with 2 smiling and 2 regular.)

Sheila S. Nazarian, MD · Answer

Don't panic. There are solutions. I would suggest starting with something non-surgical such an HA filler like Restylane for the "hallow" under the eye and perhaps a bit of Botox to address the muscle hypertrophy.  If that doesn't deliver there results the you want then you can always look at surgical options, but I always think it best to start conservatively. My best,
Dr. Sheila Nazarian
@drsheilanazarian on Instagram

John J. Martin, Jr., MD · Answer

You do have a hypertrophic orbicularis muscle which will look more pronounced when you smile.  You also have hollowing underneath this.  Some HA filler or fat into the tear trough, along with some Botox to the muscle would help.If you do a surgery, a small amount of the orbicularis muscle can be removed.  But you don't want to take much or the lid will lose its support and you will have trouble in the future.  At the same time you will need some filler or fat.

Jose Rodríguez-Feliz, MD · Answer

Thank you for posting your pictures. Tough problem, but there are solutions. Nonsurgical options may include: fillers to correct under eye hollowness, and Botox to decrease hypertrophy of the pretarsal orbicularis oculi muscle. Surgical options: Fat grafting to tear trough (I will still do some Botox to the pretarsal orbicularis oculi)A more invasive (but permanent) option would be to perform a lower blepharoplasty to remove excess skin and reduce the bulk of the orbicularis muscle, and perform fat grafting to the tear trough area.Hope this was helpful. Good luck!

Andrew Kornstein, MD, FACS · Answer

Yes, I agree. It is muscle hypertrophy and it is exacerbated with contracture(smiling).However, consider the cause, not the symptom.There is no true lateral(side view) included but based on the apparent hyperpigmentation(dark circles) and the outer corner of your eye is lower than the inner corner, you appear to have a slightly flat cheek bone below the lower eyelid. The cheek support to the lower lid and without that support the lower lid must work hard contracting against gravity---thus the muscle hypertrophy.If you were my patient, I would offer you two options:1) transcutaneous lower lid blepharoplasty(incision under your eyelashes) with muscle weakening and canthoplasty to elevate the outer corner of your eye so it is at least even with the inner corner.The outer corner of the eye drops even more with smiling, so muscle weakening laterally would be beneficial as well.2) fat grafting---long lasting and aesthetic when done properly--- would support the lower lid allowing the lower lid muscle to work less  and therefore gradually weaken(I would add Botox to help speed the process);  fat grafting would also stabilize additional bone loss as you age which tends to exacerbate these issues as well as reducing the lower lid hyperpigmentation.My preference is the second option becasue it deals with the darkened lower lid and is anti-agingHope that helps

Treatment for under eye bags caused by muscle hypertrophy and excess skin? (Photo)

Answers (4)

More Eyelid Surgery Questions

WE SEND PRETTY
EMAILS

Answers (4)

More Eyelid Surgery Questions

Can surgery make non-Asian eyes bigger? (Photo)

I have an extra fold in my right eyelid that becomes red and irritated, with an obvious red crease and itchiness. What can I do?

20 year old with drooping/asymmetrical eyelid. What can be done? (Photo)

After having a massive chalazion removed from my upper lid 2 years ago, my eye shape has changed. What can I do? (Photo)

Best procedure to lift the outer corner of the eyes? (photos)

How to fix lines/creases under eyes?

WE SEND PRETTY EMAILS

WE SEND PRETTY
EMAILS