Any Help for my Eyes, Always Look Tired/older? (photo)

Hello there, i was wondering if there are any suggestions of what i can get done for my undereye area. restalyne or blephoplasty? The skin is starting to sag, i have hollows and dark circles.. I am in my late 20s and would like to look fresher. i also have milia white spots which i need to get removed as i think these also add to the wrinkles.

Doctor Answers 9


{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}



It’s hard to be exact with your picture, but your puffiness under your eye is visible. You can do blepharoplasty for your concerns. It removes excess skin and fat deposits and gives you a fresher look. You should go see a Certified Plastic Surgeon to get a consultation and go over your option. Filler is not safe to be injected near the eye.



Beverly Hills Plastic Surgeon

Loiwer eyelid rejuvenation

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

You would be a candidate for a  lower eyelid  blepharoplasty.    If you have herniation of orbital fat causing bags of the lower lids with lack of soft tissue fullness.  These features can be corrected with a lower eyelid blepharoplasty with fat repositioning.  An accurate diagnosis of the problem is essential.  .  If the condition is only lose skin then you may want to consider SmartSkin or  SmartXide microablative fractionated CO2 laser resurfacing.   A consult would be needed to advise you which procedure would meet your expectations.  Other choices would include soft tissue fillers such as Juvederm.

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

Improving under-eye area with sagging skin

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Injectables do not help with rejuvenating the lower eyelid area.  Herniated fat pads are best treated with transconjunctival blepharoplasty.  There are 3 fat compartments on the lower lids that need to be addressed by removal of a conservative amount of fat to effect the change.  When there is scleral show, as present in this picture, it must be addressed through other techniques such as a canthopexy to raise the lower lid.  The canthopexy incision is made at the lateral corner of the eyelid and tightens up the lower lid area.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Photo is not ideal

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Although this photo is not ideal [I think you may be tilting your chin down a bit in the photo?], and we cannot see your cheek contour, you seem to have mild fat prolapse and tear troughs with lower eyelid retraction with lower lid scleral show [again, this maybe a function of chin down photo]. The hollowing may be addressed in a few ways:

1.Transconjunctival blepharoplasty with fat repositioning [not excision]

2. Fat grafting to the tear troughs [needs an experienced surgeon]

3. Restylane or Juvederm injection to tear troughs

Some surgeons are more comfortable with one technique over another, but all these techniques may give your a good result. An in person consultation would be needed to determine which is best for you.

The "milia spots" that you mentioned, may in fact be syringomas [sweat gland cysts], though that is difficult to ascertain with this photo. This is best addressed with laser resurfacing because they are too many for surgical excision. This needs to be carefully considered if you already have lower lid retraction.

If you decide to explore this further, I would recommend consultation with an ASOPRS trained Oculoplastics surgeon. You can find one close to you on the ASOPRS dot org website

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

Dark circles under eyes. Any options?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Unwanted "circles" and shadows beneath our eyes can sometimes give us a tired look. This can be caused by (1) thin skin, (2) translucent colors of vessels beneath the skin, (3) fine lines and wrinkles, (4) pigmented skin, (5) extra fatty tissue visible under the skin and muscle, and other varied causes.     Sometimes the eye globe is very prominent and the tissue beneath the eyeball is recessive, and this also contributes to a less illuminated midface/lower lid.   In a younger person, hopefully surgery can be avoided. Careful use of injectable fillers such as hyaluronic acid (like Restylane) can help camouflage some of these concerns.  However, this is not a "casual" magical procedure, performed during your hurried lunch hour, since unwanted effects can occur as well.  Carefully weigh the pros and cons with a qualified surgeon prior to treatment. 

Donn R. Chatham, MD
Louisville Facial Plastic Surgeon
5.0 out of 5 stars 75 reviews

Help For Your Tired Eyes

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Given your age, and not wanting to burn any bridges, I would start conservatively by injecting a hyaluronic acid filler (Restylane is probably best for this area) into the hollow areas underneath your eyes. This would not only help with the slightly sunken look but would also help somewhat with the dark circles (less shadow effect once the through is gone). Depending on your happiness with the results, this could be repeated as it wears off or you could consider a lower blepharoplasty. Good luck.

Michael R. Menachof, MD
Greenwood Village Facial Plastic Surgeon
4.4 out of 5 stars 28 reviews

Under eye hollows and sagging

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Given your one photo and your concerns I suspect your best course of action would be having a facial filler or fat grafting procedure to treat the hollowness under your eyes. This would help improve the contour in the area and also improve the shadowing.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews

Bags under your eyes

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Based on the picture you have shown, you have two options: a conservative transconjunctival blepharoplasty, removing a small amount of fat from the area or another options would be a filler- you have two options of temporary or more permanent. You should discuss these options with a cosmetic surgeon.

Dilip D. Madnani, MD, FACS
New York Facial Plastic Surgeon
4.9 out of 5 stars 105 reviews

Dark circles

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The milia can be excised/burned in the office.  For your lower eyelid dark circles, I recommend filler (Restylane) injections, not surgery, as you are young. See an oculoplastic surgeon.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 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.