Tired looking eyes - what to do? (Photo)

Hello, I am 42 and I've had issues with eye bags practically most of my life. But, for the past 7-8 years my upper lids have started sagging too. Otherwise, I don't have wrinkles on my forehead yet, just laugh lines (mouth) and 1 tiny line between my brows. My friend had laser treatment under eyes but her doctor said I can't do that as I am Argentinian-German mix and with slightly olive skin. Please advise what to do to look well rested and rejuvenated. Thank you.

Doctor Answers 8

Tired eye appearance

The main reason for the tired eye appearance is droopy upper eyelids (ptosis) which can be improved with eyelid ptosis surgery. The wrinkles and bags under eyes also contribute the tired look. See an oculoplastic surgeon.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 58 reviews

Droopy lids

Three conditions are often generically referred to as 'droopy lids.' The most common is hooding of the skin or dermatochalasis. Less common are drooping of the brow or brow ptosis, and incomplete opening of the eyelid itself, or blepharoptosis. Your photos demonstrate blepharoptosis. When blepharoptosis is as significant as yours, the procedure, referred to as blepharoptosis repair, or simply ptosis repair, is most commonly covered by insurance.

Daniel Lensink, MD
Redding Oculoplastic Surgeon
5.0 out of 5 stars 4 reviews

Tired looking eyes - what to do?

Hello ona74 - Thanks for your question. You appear to have upper eyelid ptosis, which is a low height to the lash margin. It makes people look sleepy. A ptosis repair surgery will raise the height of the lash margin making you appear more awake and alert. As far as your lower lids are concerned, you have some protruding fat that could be removed and any loose lower eyelid skin tightened by laser or skin excision. These two procedures together will make you look young and refreshed around the eye area. I would recommend that you consult with an eyelid surgery expert in your area for an evaluation. 

Good luck, 

Dr. Shah

Manish H. Shah, MD, FACS
Denver Plastic Surgeon
4.7 out of 5 stars 45 reviews

Eyelid rejuvenation options

On these photos, it looks like you are looking slightly down and it is thus difficult to reliably asses if there is ptosis (true drooping of the eyelid). There is excess upper eyelid skin and loss of volume centrally and laterally with some fat bulging in the inner corner. There is fat herniation (bag) on the lower eyelid above the tear trough area and possibly some flattening of the cheek area (cannot see the fully in the photo); Your non-surgical options include Botox or Dysport and filler such as Restylane. For the upper eyelid, surgery may be the best option to remove the excess skin and reposition the fat. For the lower eyelids, the bag can be "camouflaged" by placing filler around it and making the under-eye area smoother - this will improve the tired appearance. The filler in that area usually lasts 9-18 months. The alternative is lower eyelid blepharoplasty with fat repositioning. Consult a board-certified oculofaical plastic surgeon in your area to go over the specifics of each procedure. 

Flora Levin, MD FACS
Westport Oculoplastic Surgeon
5.0 out of 5 stars 12 reviews

Treatment for tired appearing eyes

Based on your photos, it does appear that you have ptosis of the upper eyelids.  This means the upper eyelid falls lower across the eyeball than it should.  This can be repaired with surgery.  The lower eyelids do appear to have some protruding fat, which can also be addressed with surgery.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

Dark Circles, Eyelid Wrinkles/Bags -- Restylane or Belotero, Laser C02/Erbium Resurfacing, Microneedling, Viva/Intensif, Fraxel

Fillers, lasers, and microneedling/PRP can improve under eye bags. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 159 reviews

Eyelid lift and lower eyelid bags

Thank you for posting your pictures. Let's talk about your upper eyelids first. You have droopy upper eyelids, which is known as eyelid ptosis. This can be corrected with an eyelid lift with a small incision at the upper eyelid crease. Since surgery is required for your upper eyelids, I would correct at the same time your lower eyelid bags with a small hidden incision inside your lower eyelid (transconjuctival approach). Both can be performed at the same time under sedation. Hope this was helpful.

Lower Lid Blepharoplasty

Hi ona74,

Thanks for your question and photos. Based on your picture and history, you appear to have lower lid fat prolapse. I can also appreciate mild ptosis (droopiness) of your upper lids. To address your lower lids, I would usually recommend a lower lid blepharoplasty with fat transpositioning. This will eliminate the bags in your lower lids and smooth out the contour of the junction of your eyelid and cheek. Your upper lids would like respond well to a posterior ptosis correction surgery. I would recommend you seek an in-person consultation with a skilled oculoplastic surgeon in your area. 

Good luck!

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.