What procedures are recommended for undereye lid bulges that occur only when smiling? (photos)

Question

am a 44 year old female and I need eye help. At rest, I do not have bags or undereye bulging but I do have discolored soon and lines. But when I smile... I develop huge, unsightly, unattractive pouches under my eyes. I've stopped taking photos unless I am wearing sunglasses. I believe I have an overactive or oversized obicularis oculi muscle. Can anything be done? I've tried Botox, it helps a little with the wrinkles but not the smile bulges. I'd rather spend my money on something more permanent.

Nelson Lee Novick, MD · Answer

From the photos and the fact that the muscles under the eyes protrude with smiling strongly suggests that the underlying problem is one of hypertrophy. And for this, the simplest treatment is the use of a neuromodulator, such as Botox, Dysport or Xeomin. I have personally been performing this treatment for well over two decades with gratifying results. It usually takes only one and occasionally two droplets instilled in the belly of the muscle in the region immediately below the pupil to relax the muscle and alleviate the problem. I really cannot say why you didn't respond to the therapy. Possible causes: too great a dilution or the product or inappropriate placement of the material are possibilities. What I would suggest, before giving up on this avenue, is consultation with an experienced board certified aesthetic physician. You may simply need a stronger concentration or perhaps a switch to Dysport or Xeomin. Best of luck.

Sanjay "Jay" Keni, MD · Answer

Hello Nyenforce,Sorry to hear of your frustrations.You are correct in your assessment: you have a prominent orbicularis muscle.Botox is the recommended treatment for this.  That being said, a more permanent option would be to excise partial thickness of the orbicularis muscle, but I would recommend you visit an oculoplastic surgeon for evaluation for this procedure.Best wishes,Dr. Jay

Paul B. Johnson, MD · Answer

Thank you for your question and photos.  You are absolutely correct in that your photos demonstrate a hypertrophic orbicularis oculi muscle.  The first line treatment is botulinum toxin (Botox, Dysport, or Xeomin).  An in-person consultation with a board-certified oculoplastic surgeon can determine if you would be a candidate for transcutaneous lower eyelid blepharoplasty with partial removal of the palpebral orbicularis muscle.

Richard Sadove, MD · Answer

Thank you for this very interesting problem.this is not a problem of herniation of excess fat.The orbicular muscle is excessive.You say that botox has failed. If I were the treating physician I would want an opportunity to do a botox treatment with my own hands as I believe that it should be able to help you.

What procedures are recommended for undereye lid bulges that occur only when smiling? (photos)

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