Stanley G. Poulos, MD

Sometimes the "tired look is not related to lax skin or extra fat in the lids which what we commonly address in eyelid surgery.Early aging changes such as yours often manifest as circles beneath the eyes and a flattening of the midface. This is caused by a loss of fat in the infraorbital region leaving thin skin over the orbital rim. When one looks at very young people they usually have upper facial fullness and you can not see a delineation between where the eyelid stops and the cheek starts.

Correction therefore is based on restoring the volume. I feel this is best done with a fat transfer but in some cases fillers may work well. I seldom do a facial surgery that is not enhanced by volume restoration and in younger patients that may be all that is needed.