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.

Doctor Answers 16

Techniques for correcting tired eyes.

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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 browlift (see book chapter referenced below). Every surgeon has their signature style for this procedure, so look carefully at the before and after pictures to see which style suits you best.

For the lower eyelids, there appears to be several issues with your eyes. First, they are prominent. The lower eyelid is sagging away from the eyeball, causing the corners of the eye to go down. Removal of any skin at all from the lower eyelid will result in a rounding or further pulling down of the corner of the eye. This will occur with certainty unless the corner of the eye is supported. We prefer a USIC cheeklift (ultrashort incision cheeklift), also referenced below. This allows support of the corner of the eye and enables safe tightening of the lower eyelid skin without any disturbance of the orbital septum, the very dangerous layer connecting the lower eyelid with the bone. In your case, there also appears to be extra fat. This can either be redistributed or reduced through a transconjunctival incision through the lower eyelid, again avoiding the orbital septum.

Especially in patients with an existing (or postsurgical) alteration of the lower eyelid, support of the lower eyelid is key. This does not just involve a canthopexy, which is inadequate in my opinion as a support technique for most lateral lower eyelid problems. Resurfacing with various lasers will help in changing skin sun damage or fine wrinkles, and is an important adjunctive procedure as well in the right patient.

So you can see we have come a long way from "upper eyelid and lower eyelids" for an eyelid shape problem.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 reviews

When your only tool is a hammer...

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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 excess skin.
Both of these issues would require surgical intervention. You could elect to have laser performed to your lower lids but only in combination with surgery for satisfactory results. Dermal fillers are terrific, but temporary.

Philip S. Schoenfeld, MD, FACS
Chevy Chase Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Eyelid rejuvenation

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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
4.5 out of 5 stars 23 reviews

Restylane for upper eyelids, Sculptra for upper cheeks

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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 your lower eyelids look long. I would recommend filling up your cheeks. You could use more Restylane and Juvederm, but my favorite cheek filler is Sculptra. You would probably get an excellent result with just 1-3 vials.

Michael C. Pickart, MD
Ventura Plastic Surgeon

Treatment for tired eyes

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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.

Elizabeth Slass Lee, MD
Bay Area Plastic Surgeon
4.8 out of 5 stars 56 reviews

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

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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

Trevor M. Born, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 126 reviews

Injectable fillers work well for lower eyelid rejuvenation.

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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
4.9 out of 5 stars 435 reviews

Lasers and injections for eyelids vs surgery

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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 way as well.

Remember, the most important part of getting a good result from plastic surgery, is the surgeon you choose.

Darrick E. Antell, MD
Manhattan Plastic Surgeon
4.7 out of 5 stars 37 reviews

Facial rejuvenation suggestions

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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 of the lower lids should be one to add volume. This can be accomplished by a suspension of the upper cheek or malar fat pad along with a suspension of the orbicularis muscle. This will give you a more youthful fullness to your lower eyelids. You can also consider botox injections to the corragator muscles to smooth out the zone between your eyebrows.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Tired Eyes of Tony in Texas

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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 fractional CO2. Obviously your results will depend on the skill and experience of the surgeon whom you choose.

Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 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.