Under Eye Bags Caused by Muscle Hypertrophy

Hi, This has been a problem since I was a little girl.  Now I'm 40 and want to improve the appearance of my under-eye bags, whether it is with surgery or fillers.

I look tired all the time and my bags just keep getting bigger as I age. I went to another consultation for blepharoplasty (eyelid surgery).

The doctor told me there's nothing that can be done, because it's all muscle and not fat. Could I have hypertrophy?  What can I do?  I can't stand to look at myself or have others look at me.  If there is surgery for this, what is it called?

-Shellee

 

Dear Shellee,

Find an experienced Botox injector.  Ask for 1 unit of Botox in the roll under each eyelid.  This might solve your problem without surgery.

(If your plastic surgeon is up on the latest treatments, 2.5 units of Dysport would also work.  Dysport is probably equivalent to Botox.)

Do be aware that this is a tricky use of Botox/Dysport.  There are a few potential (albeit unlikely) risks...

• Lowering the lower eyelid margin (so that you see white beneath your green irises)
• Loosening the tension on the fat beneath the eyes, such that bags really do become apparent (I agree with your current analysis.  You do not have fat bags, just excess muscle.)
• Causing your eyes to become dry and scratchy

I highly doubt that you will have problems, but other plastic surgeons might be hesitant to give my suggestion a try.  This is definitely a Botox/Dysport use for experienced injectors only.

If the Botox/Dysport is unsuccessful, the injector could try more.  Or, a little filler in the upper cheeks (at the infraorbital rims--the bony rim beneath the eyes) can smooth the area out.  My favorite is Sculptra.

(By the way, the world's 2nd most beautiful woman--Angelina Jolie--also has muscular rolls beneath her lower eyelids.  Shellee, you're in good company.)

(Who's the world's most beautiful lady?  My wife, of course!!)

Sincerely,

Mike Pickart

Comments

[tracey]

i had botox 3 weeks ago, after 4 days i noticed i have bags under my eyes which i never had before, is this caused by botox? some days they are heavy and other days they are small, i am havin plenty of rest to reduce them but they dont go, would be glad to hear a reply thanx.

[Michael Pickart]

Dear Tracey,

Your under-eye bags MAY be caused by the Botox.

Let me step back and clarify the picture:

Normal under-eye bags can be caused...

by excess fat (most commonly)
by excess muscle (less commonly)
Botox is a muscle relaxant.

If the under-eye bag is caused by excessive muscle, then the Botox will relax that excess muscle.

The relaxed muscle will atrophy.
The bag will look like it has gone away.
In fact, the muscle is just temporarily paralyzed; when the Botox wears off, the muscle will regain its bulk and the bag will return.
Angelina Jolie is a gorgeous lady, who has small under-eye bags from excessive muscle. If she were interested, she would be a good candidate for Botox!
On the other hand, if the under-eye bag is caused by too much fat (which is, by far, the more common situation), then Botox will not help.

Botox only works on muscle, not fat.
ButBotox will still be helpful to diminish crows feet and to raise the tail of the eyebrow.
The muscle around the eyes is called the orbicularis oculi.

This is an important muscle. It helps you blink.
Unfortunately, it also causes crows feet and contributes to frown lines between the eyebrows.
The orbicularis oculi also provides some dynamic support to the fat around the eyeballs.

This means that the orbicularis oculi helps hold the fat inside the orbits.
To some degree, the orbicularis oculi helps prevent fatty under-eye bags!
If a patient does not have under-eye bags, and if she receives Botox to diminish under-eye wrinkles, the orbicularis oculi will be weakened.

A more relaxed, weaker muscle will not be able to help hold the fat inside the orbits, around the eyeballs.
If the other structures that prevent fat protrusion are also weak, then the orbital fat will bulge out into the lower eyelid area.
So, in effect, Botox can inadvertantly produce under-eye bags.
This is unusual, but I have seen it before.

Tracey, this is all relatively complicated physiology. Please re-read the above so that you know the factors involved. Then, call your plastic surgeon. If you are dissatisfied, I am sure that he will want to know about it. I cant make diagnoses over the internet, and I certainly cant offer therapies. He might be able to help.

You are always welcome in my office in California! It might be a long flight (since I noticed that you are from the UK), but I have number of English, Scottish, and Welsh patients, and we seem to get on very well!!

Sincerely,
Mike Pickart

Michael C. Pickart, M.D., F.A.C.S.
Pickart Plastic Surgery, Inc.

428 Poli St.,#2C, Ventura, CA 93001
(805) 648-4567 | fax (805) 641-0811

To: info@pickartplasticsurgery.com