Under eye muscle hypertrophy/twitching, can it be corrected? (photos)

Hello Ingrid.  For what you are describing, you have several options.  A tiny dose of neurotxin like Botox or Dysport should be able to stop the twitching.  For the volume loss, including what you are seeing when you smile, dermal fillers often work very well.  We prefer Restylane in this area.  Finally, if there is too much loose skin (not really apparent from your photos), then a surgical option is also a possibility.  Best of luck.

There is a muscle, the orbicularis, that runs along the eyelid, just under the lashes.  In some people this is a large muscle that can look much larger when they smile.  Some Botox injected into this muscle will help to relax it so that it won't look as large when you smile.  The Botox will also help with the twitching. May also benefit from some filler in the tear trough to smooth out the whole area - and some volume below the muscle will help to soften its' appearance. 

A combination approach will give the most improvement. Fillers, lasers, and microneedling/PRP can improve under the eyes. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

A small amount of Botox may help the eye twitching improve.  For the under eye area you may find benefit from fillers which help to disguise under eye irregularities.  See an expert injector near you to learn more.