Orbicularis hypertrophy treatment?

Question

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.

Jason Emer, MD · Answer

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.

Samuel Shatkin, Jr., MD · Answer

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.

Nasimeh Yazdani, MD · Answer

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

Hope this helps,

Yazdani, MD

Corey Frucht, MD, PhD · Answer

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.

Richard Ort, MD · Answer

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

Orbicularis hypertrophy treatment?

Answers (5)