Sunken/hollow eyes? Eye bags? Only 19, what do I do? It's looked this way for years.

What do you recommend? Fillers? What will be the best for my buck and longest lasting?

Doctor Answers 2

Dark Circles, Eyelid Wrinkles/Bags Treatment -- Restylane or Belotero with Cannulas, Clear+Brilliant, Eclipse Micropen, Viva

The eyes are best treated with a combination approach of fillers, lasers, microneedling/PRP for improvement. Ultherapy/thermage, venus legacy all do well for swelling or puffiness. I would suggest consulting an expert. If surgery is an option they will recommend. Best, Dr. Emer

Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 158 reviews

Hypertrophic orbicularis muscle

This is a great question.  "Eye bags" or "puffiness" under the eyes can result from various things.  In older individuals, this usually results from fat bulging/herniation from behind the eye, and the treatment here is to remove the fat surgically.  This is called a lower lid blepharoplasty.In the photos you show, these are young individuals with what we call hypertrophic pretarsal orbicularis muscle.  The orbicularis is a circular muscle that surrounds the eye.  When we contract it, it squeezes our eyes closed.  Some individuals as in your photos have a prominent roll of muscle that becomes even more prominent when they smile or squint, since this also requires contraction of that muscle. This muscle roll is located closer to the eyelid margin than fat herniation which occurs just below, further away from the eyelid margin.To improve this aesthetically, I recommend botulinum toxin injections to this muscle.  This can flatten and weaken that muscle so that it doesn't bulge as much when you smile, squint, or laugh.  Injeting this region can also help open the eyes and make them appear just a tiny bit larger.You could also augment this with a touch of filler to blend the junction of the muscle roll at its lower border.  I would use Belotero conservatively and pretty much nothing else in that region.You would benefit from seeing an Oculoplastic surgeon who has expertise and comfort with the delicate region so close to the eyes.  If done improperly, botulinum toxin injections can cause inability to close the eyes, dry eyes, or even sagging or outward turning of the lower lid.Hope that helps!

Bradford W. Lee, MD, MSc
Palm Beach Gardens Oculoplastic Surgeon

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