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.

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.

Dear Shelee
As other doctors have noted, that thing you see as a lower eyelid bag is your orbicularis oculi muscle which is vitally important for the function of your lower eyelid. Aesthetically, that roll of muscle is not your aesthetic issue. Your issue is the hollowness under this roll of muscle which is referred to as a tear trough hollow. Given your age and your aesthetic issues, the best approach for addressing this is to fill the under eye hollow with Restylane.
The service can be very comfortably performed in the office. Results last a year or more. Essentially the hollow is filled in making look like your cheek extends to the lower eyelid crease at the base of the muscle roll.

You have a couple of options, pending an exam of course.

The muscle can be conservatively trimmed just under the eyelash area. I have successfully performed this procedure in the past, and it is done with local anesthesia and twilight sedation.

In some people a minimal Botox injection can minimize the bunching that you have in that area, but it is not a permanent correction.

Hello there! Thanks for your question and for the attached photo. You looked so young, props to that and yes, you can possibly use some improvement to enhance your natural beauty. However, your plastic surgeon may possibly correct. Blepharoplasty may not be the solution for your “eye bags” issue. That, by the way, is yet to be confirmed after careful evaluation and assessment, as they do not seem to be actual eye bags.For this case, you may either consider Botox that will help improve the natural look of your surrounding eye area or possibly do fat grafting to fill depressions that can emphasize these so-called “bags”. With all these said and done, I would highly recommend getting the opinion of a board certified plastic surgeon. Only deal with board certified surgeons to avoid experiencing possible risks. Hope this helps!

According to the picture that was presented, yes, indeed, there is a slight hypertrophy of the muscle on the lower lids. It is impossible to go in and remove this because it will leave you with a weakened and paralyzed lower lid and is not advisable to have anything done about it. There does not appear to be any fat pads present underneath the muscle. It does not appear that you are a candidate for a blepharoplasty.

In the photo, your eyes look great and I wouldn't do anything based on this photo. I would like to see a photo of your face when you are NOT smiling. Most likely, you have volume loss in your cheeks and under you eyes. This can make you look tired and gaunt even though you don't have any bags under your eyes. The best treatment for this is fat injection to the cheeks and lower eyelid depending on where you need it. This could truly brighten your eyes and whole face.
The fillers are an acceptable alternative to fat injection but the results are not as nice nor are they as long lasting. The other possibility (though less likely) is that you do have fat bulges under your eyes but they are not seen in this photo because you are smiling and tightening your lower eyelid muscles. If this were true (again less likely based on your surgeon's evaluation), surgery would help. I do not recommend trimming or removing any muscle.