Sunken/hollow eyes? Eye bags? Only 19, what do I do? It's looked this way for years.
Doctor Answers 2
Dark Circles, Eyelid Wrinkles/Bags Treatment -- Restylane or Belotero with Cannulas, Clear+Brilliant, Eclipse Micropen, Viva
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!