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Recommendations for Tired Eyes?

I'm 38, I have pictures attached, I have sun damage and a tired look. I'm really bothered by my tired look under my eyes, and I want my laugh lines filled in and my upper lids addressed.

My biggest concern though is the lower eye and tired look! I have had 4 consults and was told 3 different things from under eye injections, MiXto Laser to surgery. Please look at my pics and advise me as to what procedures you'd recommend.

I'm thinking surgery, but there are other issues with my face I want to address to look a little younger and fresh. Thank you so much for your input! Just trying to do the right thing.

Asked 27 months ago by Tony2009 in Texas

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age 35-44 eyelids eyes face male anti-aging sun damage tired eyes

Techniques for correcting tired eyes.

There are two areas to be considered, the upper eyelid and brow area, and the lower eyelid and cheek area. For the upper eyelids, an upper eyelid blepharoplasty would be a good start. Techniques vary widely, and we prefer a fat preservation technique rather than an aggressive approach to the fat. We also prefer a conservative approach to the skin rather than an aggressive removal of skin. There is also some drooping of the lateral brow which can be separately addressed through a lateral... more

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Brent Moelleken, MD

Beverly Hills Plastic Surgeon

ASAPS ASPS

When your only tool is a hammer...

After reviewing your photos I can see how there might be several different opinions with regards to your eyes. I would venture to guess, however, that the laser Mixto and filler suggestions were not from physicians who could also offer you surgery. The photos of the lower eyelids are difficult to interpret with 100% reliability, however, it appears that you have bulging of the lower lid fat and hypertrophy of the muscle giving your eyes a very full appearance. The upper lids show significant... more

Philip S. Schoenfeld, MD

Chevy Chase Facial Plastic Surgeon

Eyelid rejuvenation

You are looking a little bit downward in the photo so your upper eylid evaluation might be less precise as far as evaluating for ptosis or drooping of the upper eyelid, but I would see benefit from an upper eyelid blepharoplasty with no fat to be removed from either upperor lower eyelids! For your lower eyelids fat grafting with either CO2 laser or a lower eyelid tightening procedure done with a conservative skin pinch should be effective as well.

Robert Schwarcz, MD

New York Oculoplastic Surgeon

Restylane for upper eyelids, Sculptra for upper cheeks

For your upper eyelids, I see early "skeletonization" with relative skin excess. You could consider a surgical blepharoplasty now, and, frankly, that's probably what you'll need in a decade, for sure. However, for now, you can obscure the orbital bone with a little Restylane--just one or two syringes. This is a simple technique that works wonders for young men like you. For the lower eyelids, you are losing volume in your upper cheeks, at the rim of the orbital bone. This makes... more

Michael C. Pickart, MD

Ventura Plastic Surgeon

ASPS

Treatment for tired eyes

We are learning more about what changes happen in the face as we age. We lose volume in some areas and gain loose skin in others. What I see from these photos is that you may have some extra skin in your upper lids, and some hollowing out of the area of the lower lids and upper cheeks. So the upper lids might to well with a surgery to gently remove excess skin, but the area below the eyes would probably benefit from some filler. I use Radiesse or several of the hyaluronic acid fillers in... more

Elizabeth Lee, MD

Bay Area Plastic Surgeon

ASAPS ASPS

Tired eyes, blepharoplasty, non-surgical eyelid lift, Restylane, Botox

Dear Tony, if surgery is your preferred route then i would do this. The most important aspect of the rejuvenation is the addition of volume to the face- done with fillers or fat grafting. There are non-surgical steps as well such as Restylane to fill the hollows, Botox to soften lines and raise the eyebrows and Thermage to improve the quality of the skin. The key for male cosmetic work is that it does not change your look or 'effeminize' you. With Warm Regards, Trevor M Born MD... more

Trevor M. Born, MD

Toronto Plastic Surgeon

ASAPS

Injectable fillers work well for lower eyelid rejuvenation.

You seem to have lower eyelid grooves that cause you to notice more puffiness of the lower eyelids. Injectable Filler treatments work well to fill the grooves and improve the contour from your lower lids to your cheeks. You also seem to have droopy eyelids (ptosis), with your right upper eyelid worse than your left. If you're considering upper eyelid rejuvenation-surgery, please consult a board-certified oculoplastic surgeon. I hope this is helpful for you.

Eric M. Joseph, MD

West Orange Facial Plastic Surgeon

Lasers and injections for eyelids vs surgery

Forget the person who mentioned lasers and fillers. At best, they would be a temporary improvement and are usually recommended by people not trained in how to perform the surgery. I had my eyes done when I was 32 and it was one of the best things I ever did. I'm now 58 so that's pretty good mileage. A conservative upper eyelid blepharoplasty with a probable trans conjunctival lower blepharoplasty will make a big improvement. Period Botox/Dysport injections to the crows feet goes a long... more

Darrick E. Antell, MD

Manhattan Plastic Surgeon

ASAPS ASPS

Facial rejuvenation suggestions

There are several issues involved when considering your rejuvenation of the orbial area. A conservative upper eyelid blepharoplasty would give you a crisper appearance to this area. You have a mild degree of asymmetry of the upper eyelids with the level of the lid on the right side lower than the left. This can be corrected with a ptosis repair at the same time. For the lower eyelids there is a thinning and early ovalization of the orbital area. The primary emphasis for rejuvenation... more

Jeffrey Zwiren, MD

Atlanta Plastic Surgeon

ASPS

Tired Eyes of Tony in Texas

Hi Tony, From your question and description of your concerns, I would recommend upper eyelid conservative skin only blepharoplasty with a fractionated CO2 laser treatment (be it Mixto, Fraxel repair, or Total FX). You should have Botox to your crow's feet and forehead about one week before your treatment. It does not appear that you have excess fat pockets in either your upper or lower lids. You may also consider Restylane filler placed in your lower lid hollows if needed after the... more

Michael A. Persky, MD

Los Angeles Facial Plastic Surgeon

Improving a tired look

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... more

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Stanley G. Poulos, MD

Bay Area Plastic Surgeon

ASAPS ASPS

Tired eyes...

From your photos there is excess bulk on the upper lid giving a "curtain" appearance. Your lower lids also appear full and "baggy" giving a heavy look. The combination produces an appearance of tiredness as if you've been up all night. An upper blepharoplasty with removal of the excess fat of the upper lid and slight removal of the skin will make a huge difference. Men should have less removal of skin, but the usual removal of fat so as to not appear overly feminized. ... more

Ricardo Izquierdo, MD

Chicago Plastic Surgeon

ASAPS ASPS

Treatments for tired eyes

Hi Tony, From your answers I would BET you did not see 4 Plastic surgeons. You would GREATLY benefit from an Upper Lid Lift (Blepharoplasty) procedures. It will remove the skin hooding and give you a more relaxed look. (IF the asymmetry of the eyelid positioning bothers you, (your Right eyelid hangs lower to the pupil than the left) - in that cases you may need a mild ptosis repair on the Right). Botox injections to the bridge of the nose (between the brows) would relax the snarling muscles... more

Peter A. Aldea, MD

Memphis Plastic Surgeon

ASPS

Blepharoplasty for tired eyes

In reviewing your photographs I would recomend an upper lid blepharoplasty and possibly a transconjunctival lower lid blepharoplasty. The lower lids are hard to see properly with the Iighting from the photo. Your appearance would be greatly enhanced with surgery and should relieve the "tired look" . I would never treat you with fillers for your eyelid problem, surgery is the only answer here. Some fat transfer to the face would be beneficial to help with some of the fullness that we... more

Michael Elam, MD

Orange County Facial Plastic Surgeon

Procedures to refresh tired looking eyes

According to the picture shown, it is possible to do an upper and lower blepharoplasty to improve the tired look around the eyes. The upper and lower blepharoplasty is done under general anesthesia and takes approximately one hour, and the primary goal is to remove the excess skin and a little bit of fat and puffiness on the upper lids. The goal for the lower eyelid surgery is just to remove most of the puffiness and the fat bags on the lower lids through a transconjunctival approach. If... more

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William Portuese, MD

Seattle Facial Plastic Surgeon

Procedure for tired eyes

Hello, You may benefit from lower lid fat grafting and upper blepharoplasty. Please feel free to contact me with any further questions you may have. Thank you, and best of luck. Dr. Nassif