What to Do About Lower Eye Lid Bags/hypertrophy and Twitching Spells in Young Female? (photo)

Hello, thank you for taking the time to read this! I am a 20 year old, I have had these bags under my eyes since I can remember, definitely since around age 15. I have always had eyes that sort of "disappear" when I smile. The bags are worse when I smile and when combined with a bad night's sleep. I also have frequent twitching on both my lower and upper eyelid, spells that have lasted 10 days on my upper eyelid and 7 days on my lower lid. I don't know if this is related. What are my options?

Doctor Answers 8

You do not have lower eyelid bags.

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In fact there is absolutely nothing wrong with the appearance of your eyes.  It is also my professional opinion that you are very attractive and you should be out there flaunting your beauty not questioning yourself on a forum such as this.  The thing you call a bag is your orbicularis oculi muscle of the lower eyelid that hold the lower eyelid margin against the eye surface.  The change in lower eyelid configuration that occurs with smiling is normal and important because it tells people that your smile is genuine.  Of course under the magnification of a bathroom mirror we get all sorts of goofy ideas in our heads.  Please don't let a cosmetic surgeon cut you or inject you for this.  Regarding the twitching, if this is bother some, it might be worth getting assessed for dry eye.  If you are doing a lot of computer work or have some degree of dry eye, the spasm may be secondary to eye drying.  A careful examination by a board certified ophthalmologist can determine if your eyes are a bit dry in which case the use of artificial tears might be helpful.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Lower eyelid bags/hypertrophy in young female

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There are no herniated fat pads in either of the lower lids in the picture shown.  This patient is not ready for lower blepharoplasty.  What is present, is hypertrophy of the orbicularis oculi muscle and skin.  The twitching is a normal variation, if it becomes chronic and bothersome, a small drop of Botox can be placed for temporary improvement.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Lower eyelid bags

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As others have mentioned, you have great eyes and nothing cosmetically wrong with them.  Do not do anything you will likely regret it!  You do not have lower eyelid bags, just a young healthy robust orbicularis muscle, that is why you think your eyes "disappear" when you smile.  Leave is alone it looks natural.  As far as the twitching start with diet and lifestyle modifications.  Decreasing caffeine and related stimulants as well as a goodnights sleep should help.  It does not like you are describing blepharospasm.

Robert Schwarcz, MD
New York Oculoplastic Surgeon
4.5 out of 5 stars 23 reviews

Photos are not ideal

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To be honest, the photos you posted are taken from a bit too far away for us to be able to properly evaluate the anatomic issues.

I agree that you have a bit of hypertrophy of the  pretarsal [just underneath the lashes] orbicularis oculi. If that is the area of "bags" you are describing, then botox will likely improve it. It has to be very low dosage, however, as too much botox can cause the eyelids to roll out away from the eye, or cause problems with tearing.

The twitching problem you describe is called Ocular Myokymia, and is thought to be related to too much caffeine intake, not enough sleep, or too much stress. If  you can modify these three areas, the twitching will likely improve spontaneously, though in some patients with persistent twitching, I have used very low botox dosage to break the cycle successfully.


I would recommend posting closeup photos of your eyelids without ANY smiling at all, and then with smiling so we can better evaluate.


A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

Lower Eyelids: No Indications for Surgery

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The pictures show beautiful eyes that cannot be improved in any way by surgery.  I think the fullness under your eyes is aesthetically pleasing and a sign of youth. Botox won't do any harm but is not likely to provide a great deal of aesthetic benefit.  The eyelid twitching (blepahrospasm) may be helped, but I would first rule out other causes such as fatigue, excess caffeine, etc.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 103 reviews

Prominent lower lids and muscle twitching

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From your pictures, it appears that you have hypertrophied muscles. This is also consistent with the twitching you're experiencing. You are straining/fatiguing your eye too much and need more rest. This can be treated with some R&R for your eyes and some botox.

In your case, I don't appreciate "bags" underneath your eyes from excess lower lid fat. Some people do have this problem in their 20's. If this were the case, then it is treated with lower lid blepharoplasty from the inside of your eyes as to avoid leaving any external scarring. 

Perry Liu, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 5 reviews

"Bags" and muscle twitching of lower eyelids.

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I agree with Dr. Ishoo in that there does not appear to be much redundant tissue to be surgically excised and Botox will likely work very well and be much easier and less expensive.

Brian J. Lee, MD
Fort Wayne Plastic Surgeon
5.0 out of 5 stars 13 reviews

Lower eyelid fullness

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You appear to have orbicularis occuli muscle hypertrophy which you see as fullness and also the cause of your eyes "disappearing" when you smile. I dont appreciate any significant fat herniation or skin excess. I usually treat conservatively with a few units of Botox directly into the inferior orbicularis muscle. This may also help with reducing the "twitching" or muscle spasms that you describe.


Edwin Ishoo, MD
Cambridge Facial Plastic Surgeon

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.