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I look so tired and old. What are my options for my eyes? (Photo)

I am a healthy 35 year old woman. I look at pictures from 10 years ago and my eyes look like this. Why? I have done the cucumbers, cold packs, drinking more fluids, sleep the right amount, lotions, vitamin C, retinol and massage. My father has this under his eyes but 100 times worse - Is this where my eyes are heading? Any suggestions would be great. Is surgery the only option. When I push skin towards my nose it goes away totally. Lifting up distorts my face and eyes.

Doctor Answers (12)

Options to Improve Your Puffy, Tired Lower Eyelids

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The anatomic reason that this under-eye puffiness occurs is that the connective tissue - located between the lower eyelid lash line area and the rim of bone below the eye, called the infraorbital rim of bone, which holds the fat around the eye in place - stretches over time. In your case, this may have happened at an early age due to a familial tendency. Because of this anatomical ‘weakened’ connective tissue, the fat in the area bulges out to create a “pseudoherniation” (similar to a hernia anywhere else in the body, except the “pseudo” prefix applies because it just appears to be bulging out, rather than a true herniation).

The use of topical skin care products are an excellent idea for keeping the fine lines and wrinkles in this area at bay – so, I definitely recommend you continue a good skin care routine around the eyelid skin – but these products won’t prevent or treat the puffy, tired look.

The good news is that the puffy, tired eyes problem is very easy to fix with a minor surgical procedure: using a transconjunctival approach (so that there are no visible scars). Some of the bulging under-eye fat can be removed, some of it can be repositioned and the firm fibrous attachment right next to the nose (called the arcus marginalis), that creates the appearance of a deep groove there, can be released.

This option will give you a very natural-looking contour in this area, that will make you look healthier and more rested. Since there are no visible scars, the recovery from this procedure is very quick – only limited by any bruising you may have for a few days. Lower eyelid surgery patients are often some of the most satisfied cosmetic patients because eyes are such a central source of  communication and appearance.

Check out this link to get a visual perspective of the type of improvement you would see from your own lower eyelid blepharoplasty...


Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 11 reviews

Lower Eyelid Bags

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In reviewing your photographs you have both a tear trough deformity and also bulging of the lower eyelid fat compartments.  You would do well to have a judiciously performed lower eyelid blepharoplasty along with some filler or fat injected along the tear trough area. 

Michael Sundine, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 15 reviews

Options for lower eyelid "bags"

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A great part of your tired appearance is from the lower eyelid "bags" (fat) and hollowness underneath it.  Lower eyelid transconjunctival blepharoplasty (where the existing fat is moved into the lower hollow area) is a great long-lasting, natural option. Filler injection into the hollow area can also achieve improvement.  See an oculoplastic surgeon for evaluation.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
5.0 out of 5 stars 9 reviews

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Fillers would be the best nonsurgical solution for your tired looking eyes.

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You have some fat prolapse, and right under that some hollowing in the tear trough.  Your options are:  surgery with fat repositioning where the prolapsed fat is moved down into the tear trough to make it appear smooth.  Non-surgical options would be to put a filler  the tear trough which would make the prolapsed fat less noticeable.   

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 7 reviews

What to do for tired looking eyes ?

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Any advice is limited as an examination in person would be required. Based on your photo, you have a combination of loss of volume under the eyes and some herniation, or 'pushing out' of under eye fat. Your options range from least invasive to more, with the more invasive options being more permanent. However, nice results can be obtained with the lesser option. 
So, to start with, the least invasive would be to perform some kind of filler around the area, to build up the upper cheek/lower eye loss of volume around the fat that has herniated, options for filler vary from different types of HA (hyaluronic acid) fillers to fat transfer. 
Your other option would be a lower eyelid blepharoplasty, there are different approaches and an examination would be required to determine which, if any, would be beneficial for you.

Dilip D. Madnani, MD, FACS
New York Facial Plastic Surgeon
5.0 out of 5 stars 29 reviews

Options for tired looking eyes?

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Fillers often can produce a nice temporary cosmetic improvement in some patients, but not all. They certainly do not achieve what a well performed blepharoplasty will do.

Fillers can help improve the cosmetic appearance but you will get only a temporary and limited improvement with them. A better and long standing correction would be achieved with a blepharoplasty of the lower lids: Conservatively removing any excess loose skin that may be present, contouring the bulging fat pads, which are generally inherited, unrelated to weight, and tend to protrude more with time, and smoothing the tear troughs with micro-fat grafts or fat repositioning.

Keep in mind that following advice from a surgeon on this or any other website who proposes to tell you what to do based on two dimensional photos without examining you, physically feeling your tissue, assessing your desired outcome, taking a full medical history and discussing the pros and cons of each operative procedure would not be in your best surgery. I would suggest that you find a surgeon certified by the American Board of American Plastic Surgery and one who is ideally a member of The American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.

Robert Singer, M.D., FACS

La Jolla,California

Robert Singer, MD
La Jolla Plastic Surgeon
4.5 out of 5 stars 15 reviews

Puffy lower lids

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anderson6791, I would recommend a "SOOF lift blepharoplasty", please see my web site for further information. I've been using this approach for over 15 years with excellent results. Good luck!!

M. Sean Freeman, MD
Charlotte Facial Plastic Surgeon
5.0 out of 5 stars 19 reviews

Puffy and tired lower eyelids

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The puffy and tired look of the lower lids is caused from herniation of the 3 orbital fat compartments. At 35 years of age, a trans-conjunctival approach for conservative fat removal will address rejuvenating the lower lids. For many examples please see  the link below

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 58 reviews

Lower lid puffiness

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I would agree with the other reviewers. A good in person exam would be the ideal way to get an answer. You could go with fillers or eyelid surgery. You seem to be a candidate to have the fat removed from inside the lid leaving you with no scar on the outside and a quicker recovery time should you go that route. Fillers need to be repeated and it is put in the hollow to hide the puffiness. 

Rick Rosen, MD
Norwalk Plastic Surgeon
5.0 out of 5 stars 9 reviews

Based on the photograph, one can't know precisely what is causing your bag.

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An actual in person consultation is needed to determine this.  You actually have more of a hollow than a bag.  I think if you found a skilled injector you could do quite well with fillers rather than surgery for quite some time.  The fluids, sleep, vitamin C, retinol are not going to make a difference.  Massaging this will make it worse.  I would recommend getting some consultations.  I would be careful.  Try to avoid having the eyelid cut as the first option.  You are not in the ideal part of the world for getting cosmetic surgery services.  Less is more.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 16 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.