What Do you Recommend To Address Tired Eyes, Upper Eyelids And Laugh Lines? (photo)

I'm interested in doing as much as possible to improve my appearance. My biggest concern is my tired looking under eye area. I also want to address my upper eyelids and laugh lines. I will do surgery if needed, but I was wondering if injections (under eye and laugh lines), and maybe Botox would significantly improve my appearance? Please let me know what you think. I'm in Texarkana so I'll be seeing a doctor in either Little Rock, Dallas area, or Shreveport. Thank you.

Doctor Answers 7

Avoid fillers such as Restylane and Juvederm for puffy lower eyelids

You would need an examination, but if it turns out that your lower eyelid puffiness is from swelling of fluids, which can be from sinus problems or allergies, then fillers such as Restylane could absorb fludis and make your eyelids more puffy.  if it is fat herniation that is producing these bulges , then surgical blepharoplasty is expected to give you the best result, and you would be wasting your money on Botox, Fraxel laser and fillers.  Your laugh lines can be treated by injecting them with Restylane, Juvederm or other fillers that your physician may find appropriate for you.

Manhattan Dermatologic Surgeon
4.9 out of 5 stars 37 reviews

Suggestions for Tired Eyes

Hi Tony.  Our suggestions are as follows.

Because the priority is the under eye area, we would suggest Restylane to start.  You would probably require between 1-2 cc's of Restylane because there is a lot of volume loss below the eyes.  The tear trough area below the eyes is extremely technique dependent so find someone that knows how to inject this area "under the muscle" for best results.  Try addressing this issue with filler first and if you are not happy with the results then it may be best to consider surgery.

We would use Botox (or Dysport) for the area between the eyes and the forehead.  We would need to see you smiling to see if we would recommend the same for the outer eye (crow's feet).  A "Botox browlift" can lift the outer eyebrow a millimeter or two making the eyes more open and less tired (see link below).  Good luck.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.3 out of 5 stars 6 reviews

Rejuvenation for Tired Eyes

 I feel Botox is the best treatment for laugh lines caused by facial animation. If there are grooves present lateral to the eyes at rest, which I don't see in your picture, fillers are beneficial. Your lower lids would be improved with the injection of fat or fillers like Restylane to minimize the hallow appearance because the loss of volume ages all of us. Compare the faces a child and an older person, man or woman. I do not see any significant fat bulges in the lower lids. Very minimal skin can be removed from the upper lids; too much excision will feminize your lids.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

What Do you Recommend To Address Tired Eyes, Upper Eyelids And Laugh Lines?

 IMHO, the upper eyelids are still OK.  The lower eyelids show signs of fat bags that would respond well to a transconjunctival lower eyelid surgery.  Fillers like Perlane and Radiesse can be used to fill in the laugh lines (NLF's).  The lower face appears heavy but the photo is cut off preventing further evaluation.  

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

I recommend caution.


You have a big face and big eyes.  It is essential to find a surgeon who is conservative.  For the upper eyelids it is essential to maintain as much of an upper eyelid fold as possible.  A minimal skin excision is all you need here.  The goal is for the upper eyelid fold to expose about one more millimeter of upper eyelid platform.  When too much upper eyelid skin is removed, the upper eyelids look feminized.  This is not something guys like (think Kenny Rogers).  For the lower eyelid, here less is more.  Please do not let a well meaning surgery approach your lower eyelid through a skin incision below the eyelashes.  The issue is cutting through the muscle just under the skin.  This will undoubtedly compromise the lower eyelid and give you a dog eyed appearance after surgery.  Transconjunctival surgery with arcus-marginalis release is preferred.  That surgery moves the lower eyelid fullness from the lower eyelid where you do not need it to the top of the cheek.  An alternative would be careful unde reye circle fillers but this can be a fussy treatment.  Some guys don't have the patience for it.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Botox and filler

Botox and Restylane would improve your appearance. The lower lid bags should be treated with Restylane and Botox can be injected above the eyes. However, your photos do demonstrate upper lid redundancy and you may want to inquire about an upper lid blepharoplasty if and when you are ready to undergo surgery.

Robert L. Kraft, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 40 reviews

Botox works for forehead wrinkles for not for under eye bags

If you main concern is your under eye bags and heavy upper eyelids, the answer is not with Botox.  You should consider consulting a skilled plastic surgeon about a blepharoplasty.  Laugh lines can be promptly corrected with a filler such as Juvederm and Restylane, not Botox.

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 75 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.