Solutions for Hypertrophic Eye Muscle Bulge?

Question

I have what has been described to me as a hypertrophic muscle under my left eye. I also have undereye hollows. I've been told that injectables would improve the hollows but not the eye bulge, which is what bothers me the most. Will Blepharoplaty help or are there any other solutions? Thank you!

Brent Moelleken, MD · Answer

There are no solutions that dissolve muscle without damage to the very delicate surrounding tissues. 
From your picture, it appears that you are too young to undergo surgery and that these bulges are actually normal in young patients, in my opinion.  In older patients who have had previous blepharoplasty by an aggressive subciliary approach, we actually often build a slight muscle roll when we reconstruct the lower eyelid, in conjunction with a superficial cheeklift.  The atrophic, overly flattened, contourless lower eyelid look is definitely out!
For older patients or patients with a more severe problem, orbicularis muscle tailoring can be performed (usually in conjunction with a subciliary cheeklift) but it requires an incision along the lower eyelid.  This would be an unacceptable sacrifice for a young patient with no existing scars.  We have many patients who underwent cheeklift and muscle tailoring surgery on our website and in publications.
Botox to the lower eyelid muscle roll would theoretically work as well, but often the results are accompanied by slight artifact, so not beneficial to the patient.
Filler such as Restylane or Prevelle is a nice option if the problem is bothersome enough; this can reduce the appearance of lower eyelid muscle hypertrophy.

Trevor M. Born, MD · Answer

Dear RKris
Does the fullness get better with slight squinting of the eyelids?  is the fullness there all of the time or does it come and go?  Do you ever see this in the right side?
There are many approaches to softening the appearance of the 'muscle'.  As you can see above - there is no one opinion.  Botox is an easy solution however it may result in the lower lid dropping a small amount. if you try this- it is reversible thus if you do not like it it will wear off.
Filling the hollows may help disguise this- using fat grafting or filler injections.
Some may advocate removing a small amount of muscle.
With the surgical procedures- a caution- the shape of your lower lid - it should be supported with a canthal support suture (the tendon of the lower lid) so that the lower eyelid does not drop down.
With Warm Regards,
Trevor M Born MD

William Portuese, MD · Answer

A blepharoplasty is not going to help with eye muscle bulge on the lower lids.  The goal of a lower blepharoplasty is to remove herniated fat in the lower lids and remove a small strip of skin as a pinch technique right at the lower lash line.  Lower eyelid blepharoplasty is not done to improve muscle hypertrophy.

Christopher L. Hess, MD · Answer

You have an interesting appearance.  Although you are quite young you do have a fullness over the tarsus of the lower lid.  The obicularis oculi muscle that closes the eyes is divided into three areas of which one is the pretarsal or muscle over the tarsus.  It is interesting that only one eye has this fullness.  Although less common, but still possible, is the SOOF fat or fat under the muscle.
This is one area of the muscle that is essential for lower lid function and support.  I would recommend seeing an ophthalmologist to see if there is a reason that only one eye would be hypertrophied.  You do not need fillers at this stage.

Brooke R. Seckel, MD, FACS (retired) · Answer

I do not use filler or fat injetcions under the eyes. Unsightly lumps are common and blindness has been reported in England following filler injection under the eye.
The proper procedure to correct under eye hollows or dark circles is an arcus marginalis release and fat grafting or repositioning.
If an external icision is used during the arcus release, the L orbicularis occuli muscle can be contoured to reduce the bulge.
These are sophisticated plastic eyelid procedures, you need to see an experienced expert in eyelid plastic surgery.
See before and after arcus release and fat grafting pictures

Solutions for Hypertrophic Eye Muscle Bulge?

Answers (5)

Answer: You need a thorough evaluation

Answer: You need a thorough evaluation

Answer: Avoid injections for under eye hollows - Eye muscle bulge can be corrected

Answer: Avoid injections for under eye hollows - Eye muscle bulge can be corrected

Recommended reading

Everything you need to know about Eyelid Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.

Solutions for Hypertrophic Eye Muscle Bulge?

Answers (5)

Answer: You need a thorough evaluation

Answer: You need a thorough evaluation

Answer: Avoid injections for under eye hollows - Eye muscle bulge can be corrected

Answer: Avoid injections for under eye hollows - Eye muscle bulge can be corrected

Browse related questions

Recommended reading

Everything you need to know about Eyelid Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.