Options for Under Eye Bags Caused by Muscle Hypertrophy?

Hi Shellee,
Unfortunately we are our own worst critics.
You have a beautiful face, smile, and believe it or not ,eyes. Sorry that you feel uncomfortable with others looking at you, but as a facial cosmetic surgeon, I will give you my opinion...actually I already have above.
If you were my patient I would treat you most conservatively, beginning with very low dose Botox placed just below your lower lash line. Let that settle for a few weeks and see how you like the result. Once the Botox has had it's affect then evaluate whether injecting Restylane into the lower lid hollows would be indicated.
I would advise against surgery unless you find a highly qualified ophtalmo-plastic surgeon who felt that they could help you (Robert Goldberg, MD at UCLA, Kenneth Steinsapir MD, and Jonathan Hoenig, MD, all in Los Angeles). Even the hands of those experts, surgery should be a last resort.
Now go out there and let all those Texans enjoy your pretty face.
Good luck and be well.
Dr. P

You do appear to have a ridge of excess muscle underneath your lash line. I have on occasion removed a small strip or orbicularus muscle in patients who required it (these were extreme cases). It require careful judgement as you do need that muscle for proper eyelid function. My preference is to inject a bit of Botox in situations like these in order to allow the muscle to atrophy a bit. The results are subtle. My suggestion would be to take the advice of others here. You have lovely eyes and the ridges underneath your eyelids do not detract from your appearance. I have encountered patients with your situation, and I like to show thempictures of babies. Lots of babies have lower eyelid ridges, and we certainly don't consider them unattractive.

You have a lovely face and I don't think you would benefit from surgery at this time, especially since the modifying the muscles could contribute to an undesirable result.

Hi Shellee:
would consider a little filler under your rim and some botox to decreasing the orbicularis contraction that is causing you to have a more significant orbital rim depression.  Surgery a bit drastic for you slight problem.  I prefer to use Radiesse under the muscle and just below the rim.

Dear Shellee, what you are describing and whag can be seen in the photo may not be the same. Muscle hypertrophy of the lower wywlid can be treated with a little Botox and if there is an underlying hollow- this can be corrected with micro fat grafting or placing Restylane on the deep layer in the hollow on the bone.
With Warm Regards,
Trevor M Born MD

Your doctor was correct in identifying this as a muscle problem.
Some have suggested Botox, and others excision of muscle. I would try the Botox first to see if you like the effect. If you do like it and decide to go ahead with a blepharoplasty, make sure the surgeon excises ONLY muscle, and not skin. You have no skin excess, and skin resection might cause scleral show, where the whites of your eyes show under the cornea.
When I look at your picture I see a pretty woman, as many others have noted. You do have a little bit of a hollow underneath your eyelids which you have noticed but many others don't. This area under the lids, specially on the medial aspect of the under eyelid area could be treated with fillers. First try a filler such as Radiesse or Juvederm to the area, and if you like the effect you may get permanent fat grafts.
Read the post below re. fat grafts under the eyes.