Orbicularis hypertrophy treatment? (Photo)

I've had puffy under eyes for as long as I can remember. They are especially puffy in the morning and tend to get a bit better as the day goes on. I'm 30 y/o & look tired. I consistently get a full nights sleep, drink 2-3 liters of water a day, eat a low sodium diet, and sleep with my head elevated. I am wondering if you think I have orbicularis hypertrophy and if Botox would work well to reduce. I really would like to stay away from surgery if at all possible. Thank you in advance.

Doctor Answers 10

Orbicularis hypertrophy when smiling

Thank you for asking about your lower lids.

  • You have a visible fold of muscle at the rim of the lower lid -  often considered a sign of youth
  • However if you do not like it, a very small injection of Botox directly into the fullness should soften it.
  • The morning puffiness sounds more like air borne allergies, e.g. to a pet, pollution, etc., rather than orbicularis hypertrophy.

Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Orbicularis hypertrophy treatment?

Hello, and thanks for your question and photos. In my opinion, there are a couple of issues that would need to be addressed in order to optimally treat the lines that are bothersome to you. First, I would start with a small amount of Botox in each lower eyelid to address the component of orbicularis hypertrophy (i.e., thickening). This would relax the circular muscle around your eyelid, therein minimizing the appearance of this muscle as it contracts. Importantly, I also think you would benefit from some volume correction to minimize the appearance of your tear trough area. In this area I prefer Restylane, which tends to draw less water than other fillers, but there are other products that work well in this location. This is one of my favorite procedures to perform, as patients instantly look more rested, but it's difficult for friends/family to notice that a procedure was performed. In order to determine the best treatment plan for you, I recommend an in-person consultation with an expert. Best of luck, Dr. Frucht. 

Corey Frucht, MD, PhD
Santa Barbara Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

Eyelid Wrinkles/Hypertrophy - Restylane or Belotero, Clear+Brilliant/Fraxel, Microneedle/PRP, Viva/Intensif, Botox/Dysport

There are many ways to improve the increase muscles around the eyes.  Botox, microneedling/RF, and lasers work the best for improvement.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 166 reviews

Orbicularis hypertrophy

i would consider a small amount of Botox placed into the lower eyelid.  In my experience this is helpful for bulging of the muscle when people smile.  Also, Botox is temporary so if you don't like it, the effect will wear off.  

Best regards,

Dr. Ort

Richard Ort, MD
Lone Tree Dermatologic Surgeon
5.0 out of 5 stars 22 reviews

Roll under my eyes when I smile.

This can be treated with just a few units of botox.  This will help the muscle stay more relaxed even when you smile.  I have found the botox has to be placed near lower lid margin (a few millimeters away from the lashes inferiorly).  It can bruise easily in this area, but is otherwise very safe.  Your eyes are otherwise already beautiful.  Go to an experienced botox (wrinkle blocker) injector if you decide to have it treated. Best regards.



John R. Burroughs, MD
Colorado Springs Oculoplastic Surgeon
5.0 out of 5 stars 14 reviews

Orbicularis hypertrophy bulges when smiling

I would say that a small amount of Botox in the lower lid will help the bulging noticed during smiling. In a young person, there is no risk for ectropian, but for the older patient, a snap test needs to be performed to make sure there is enough tension in the lower lid before proceeding.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.6 out of 5 stars 27 reviews

#PuffyEyes

Dear bk9079:

   First of all, let me say that you have a lovely smile and beautiful eyes, and if you did nothing at all I would say, great.  But if you really want to tweak things I do agree that there is an #InfraorbitalRoll when you smile, indicative of hypertrophy of that portion of your orbicularis oculi muscle, which would flatten with a tiny amount of #Botox.  In addition, there is a subtle #TearTrough, more under your left than right eye, which would flatten with a small amount of #Belotero (or #Restylane).  Here's the kicker: you also describe, and it is apparent in your photos, a mild amount of infraorbital edema, despite a low-salt diet and adequate fluid intake. Which might worsen with either of these treatments. Muscular contraction helps to pump excess fluid out of this area via the lymphatics, and weakening the muscles with Botox might temporarily impair this function.  Injecting a filler can put pressure on the lymphatics, making it harder for them to drain.

You might first try improving the edema. Apply a potent green tea-containing cream in 3 to 5 layers every morning (see below for one with 90% green tea polyphenols) and increase your potassium intake, which helps by making your kidneys secrete more salt, for example by drinking coconut water.  If you are still unhappy, try 2 units of Botox under each eye, in the rolll itself, before having any filler.

   All the best,   Dr. Clark

Sheryl D. Clark, MD
New York Dermatologist
5.0 out of 5 stars 7 reviews

Botox for puffy under eyes

If the puffiness below the eyes is most noticed during smiling, it is typically from contraction of the orbicularis muscle (under eye muscle).  Usually a small amount of botox (1-2 units) to start with is all that is needed.  If the patient with bulging below the eyes has any degree of skin or lid looseness, this would not be a good method for treatment as it may cause more sagging due to less muscle support.

Samuel Shatkin, Jr., MD
Buffalo Plastic Surgeon
4.8 out of 5 stars 15 reviews

Eye hollows

You have a sunken area under your tarsal plate.  Botox won't help with this.  Fillers would be helpful.  A more permanent solution would be fat injections but this requires a minor surgery.  Seek out a board certified surgeon for a consult.  Best wishes.

David Alessi, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 11 reviews

Heavy lower lids

I don't believe short of surgically removing the fat pad around the lower lid, you'll get far from any procedure.  The edema you see in the morning is normal from fluid accumulation around face, and in your case it exaggerates the puffiness around eyes.  Your frontal photo shows slightly sunken mid cheek volume.  I would fill the mid cheek and a bit in troughs with HA (restylane) using a microcannula, which will offset the appearance of puffiness around eyes.  

Hope this helps,

Yazdani, MD 

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.