What can i do to fix a bulging undereye? Lower bleph? Fat pad repositiononing? (Photos)

Question

Hi! I have always since childhood had these bulges (jelly rolls) under my eye that are really only prominent when i smile. When my face is relaxed theres no bags and no bulging. This leads me to believe it may be a muscle not a fat pad? I’ve had jelly roll botox in them before and it works well but now that im getting older I’d like a more permanent fix. Im Not sure if im a good candidate for something like a lower bleph because i have no bags or bulging unless im smiling or expressing. What procedure would fix this? Or minimize the bulge? I feel like it really closes off my eye area. ill add photos from ages 10-13 so you can see it’s always been there and now im 27 still here. I also will show how resting its not t lnoticeable at all my under eyes lay flat

Bianca Knoll, MD · Answer

thank you for posting your question. Reviewing your history and looking at your pictures, it seems that the cause for your concern is the ocularis muscle. You had it even as a child, and it responded to botox. A hypertrophic ocularis muscle can be treated when a lower blepharoplasty is performed, until then you may just want to continue with careful botox injections by a provider who is really versed to avoid complications in that area.  An in-person consultation with an oculoplastic surgeon might be something to consider.  I hope this helped.

Frank Agullo, MD · Answer

You already answered your own question. A roll that shows up only when you smile and goes flat when you relax is muscle, the pretarsal orbicularis bunching up right under your lashes. It is not a fat pad. Your photos make it obvious, flat at rest, rolled when you grin, and you have had it since you were a kid. So a lower bleph is the wrong tool. Bleph takes out fat and skin, and you have no excess of either. On a 27 year old that operation buys you a real risk of the lid pulling down and white showing under the eye, for a problem it would not even fix. The Botox you are already doing is the answer, and it is the cleanest one. Could someone debulk a strip of that muscle surgically? Yes, but contour dents, asymmetry, a lid that sits wrong, those are all on the table, so almost nobody does it for this. And honestly that little roll reads young. I would keep doing the tox.

#StayBeautiful,

@RealDrWorldWide

#StayBeautiful,

@RealDrWorldWide

Nelson Lee Novick, MD · Answer

Under-eye "jelly rolls," particularly those that become appear or become more prominent with smiling have been treated safely and effectively for many years already using microdroplets of Botox spaced throughout the "belly" of the jelly rolls (I.e. the under-eye muscle). I have personally been performing this procedure for at least two decades. In the hands of an experienced injector, the treatment should take no more than five to ten minutes to treat both under-eyes with desired results appearing in anywhere between one to fourteen days following treatment. You would be wise to consult with an experienced, board certified cosmetic dermatologist injection expert and best of luck.

What can i do to fix a bulging undereye? Lower bleph? Fat pad repositiononing? (Photos)

Answers (3)

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