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 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.

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 the upper cheek and find that this is a simple way to improve the tired baggy look under the eye that can come from loss of facial volume. Fillers are great to use because the improvement is immediate and the downtime is minimal. Remember though that this is advice given only based on a front view photo. Definitive recommendations can only be made in person during consultation with a surgeon. Make sure you see one who does both fillers and surgery. That way, you will be working with a surgeon knowledgeable about multiple different approaches for improving your tired appearing eyes.