Options for under eye muscle bulge?

Question

Hi, I have had these since I was little and I am in my late 20s. The right muscle is very big and the left has a double layer. I have been told they are muscle so there is nothing that can be done. The unevenness is unflattering and I look tired all the time. I have lived with them all my life and am curious if there are any options to help make them look even and make them smaller. Thank you!

Bradford W. Lee, MD, MSc · Answer

Hi there,

You're noticing the asymmetry between your right and left lower eyelid pre-tarsal orbicularis muscle (the part of the muscle that is closest to the eyelashes).  The muscle on the right side is a bit more hypertrophic (bulky). You may notice that it contracts and gets puffier when you smile or squint your eyes.  You could try treating this muscle on the right side with a very small dose of botulinum toxin and this would serve to make it contract less and atrophy just a bit.  If that doesn't do the trick, this could be addressed through a fairly simple lower eyelid surgery to debulk that muscle and remove a tiny amount of skin via an incision just below the eyelashes such that--if done properly--it heals virtually without a trace.

Hope that helps!

Adam Scheiner, MD · Answer

Dear Swappa, It does appear that you have an issue with a thickened pre tarsal orbicularis roll.I've had success using small amounts of botox to weaken this muscle. Over time, if you continue these treatments, the muscle will become smaller and result will become better. I hope this was helpful.

Mehryar (Ray) Taban, MD, FACS · Answer

If there is hidden under eye fat that is making the bulge more prominent, then blepharoplasty can help. Botox injection is also an option to reduce muscle prominence. Best to see an oculoplastic specialist for evaluation.

Camille Cash, MD · Answer

Botox in a very small amount may help.  I recommend seeing only a very experienced injector due to the delicacy of the area.  You could also consider eyelid surgery to address the area.  Visit with a board certified plastic surgeon in your area to discuss your options and learn more.

Paul Nazemi, MD · Answer

Thank you for your question.  The muscle can be treated with conservative botulism toxin (i.e. Botox) to reduce contraction and asymmetry between the two sides.  See a specialist for an in-person and comprehensive examination to learn more. Best wishes.

Options for under eye muscle bulge?

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