I am 44, always being hold I look tired despite following the holy grail of sleep,water,antihistamines? (photo)

I am wondering if I fillers would solve my problem?

Doctor Answers 16

Tired look

Hi. The tired look is secondary to your heavy upper eyelids and fat herniation of the lower eyelids. A bilateral upper and lower blepharoplasty should give you an excellent result.

San Antonio Plastic Surgeon
4.9 out of 5 stars 51 reviews

Tired looking eyes, despite adequate sleep, hydration, and antihistamines, can be helped with a surgical and non-surgical combo

From my experience of over 20 years of doing eyelid surgery, patients constantly come in and say that they’re so sick of looking tired. There’s an unconscious communication that occurs when people meet you for the first time or when friends and family see you; the eyes have such a dramatic impact on how you communicate to others that it affects a person’s perception of you. When people look at you and see that you have puffiness under your eyes or you have extra hooding of skin over your eyes, then that communicates lack of energy and tiredness. There are also psychological studies where people look at the eyes alone and they made some conclusions as to the emotional state or the attractiveness of that individual.

Looking at your eyes, the dominant feature is the puffiness under your eyes. My recommendation based on the photos alone, in the absence of a physical examination, is lower eyelid blepharoplasty. This is a surgical procedure that involves addressing the puffiness that is caused by lower eyelid fat prolapse. In my practice, we perform this procedure under local anesthesia with LITE™ IV sedation which allows for quicker recovery. For someone who is relatively young, I would do a transconjunctival blepharoplasty which means addressing the fat pockets from the inside of the eyelid to avoid any outside scars and preserving the anatomy and support of the lower eyelids. In addition, we would also do other procedures such as fractional CO2 laser and platelet-rich plasma to help improve the skin quality. These non-surgical treatments would require a little bit more detail and evaluation of the skin and it’s something I can’t comment on based on your photos alone.

The lower eyelids are an interesting choice for someone who has a little bit of hooding. Sometimes, people who have full upper eyelids say they don’t want to change that, so I don’t push them. It’s up to them to make a decision of what they want to do. Some patients, who had a tight and full upper area when they were young, unfortunately, lost volume and the skin now looks loose and hanging. To evaluate the need for surgery, I use a Q-tip and roll the skin to show them what their upper eyelid could potentially look like after. Most of the time, I would do a conservative removal for someone who has had a full eyelid for most of their life.

I think that fillers are not likely to be a benefit to you and that you should investigate some type of eye rejuvenation procedure. I suggest that you find some experienced and qualified cosmetic surgeons who you can meet with and get a sense of their style and your confidence of them to do the procedure you desire. If you feel comfortable and safe, move forward with the procedure. I hope that was helpful, I wish you the best of luck, and thank you for your question.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 70 reviews

Facial heaviness and tired look

If you are always being told that you have a tired look, you might want to be seen by a plastic surgeon to be properly evaluated for either fillers/botox and/or facial surgical procedures. Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Sometimes combining surgical with non-surgical treatments will give you the best outcome.

The lower eyelid area is one of the most challenging areas to address.There are both surgical and non-surgical options depending on your particular anatomy. Sometimes combining surgical with non-surgical treatments will give you the best outcome.

I recommend that you consult with your local board certified Facial Plastic Surgeon who can thoroughly evaluate your history and design a treatment plan that is right for you.

James Chan, MD
Portland Facial Plastic Surgeon
4.9 out of 5 stars 58 reviews

Fillers can camouflage the hollowness under your eyes.

It appears that you have lost the support of the fat in the lower eyelids. This fat can either be addressed surgically or the trough just below it can be non surgically filled to eliminate some shadow. You may also have some redundancy in your upper eyelids can easily be corrected surgically.

Leila Kasrai, MD, FRCSC
Toronto Plastic Surgeon
5.0 out of 5 stars 66 reviews

You would benefit from a blepharoplasty.

A picture straight on would be helpful - this is taken from a little above. But it appears that you have some excess skin in the upper lid which can be removed. You also have some prolapsed orbital fat and a dark tear trough which can make you look tired. A lower eyelid blepharoplasty with transposition of the fat into the tear trough will help to smooth out the appearance of the lid, and make the dark circles less prominent. Find a good oculoplastic surgeon in your area to do this for you.

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 27 reviews

Blepharoplasty, not fillers is the best option for tired look

Thank you for your question and photograph. An upper and lower blepharoplasty will remove eyelid hooding and puffy bags from lower eyelids.

Choose an expert plastic surgeon who is certified by the American Board of Plastic Surgery, experienced in eyelid surgery and who has an excellent reputation in your community.

Addressing the "Tired Look"

You do have excess skin of the upper eyelids which can be removed. If you do have low eyebrows( I cannot tell with this picture) they can be lifted while lowering your apparently high hairline with the Irregular Trichophytic Hairline Incision that we described many years ago.The fullness of the lower eyelids can be reduced with an incision on the back of the lids. All of this will provide a more rested appearance.

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

Blepharoplasty for improvement of tired look

The primary goal of an upper blepharoplasty is to remove excess skin and a little but of fat which is worsening the hooded look. The primary goal of lower eyelid surgery is to remove the 3 compartments a fat through a trans-conjunctival( inside the lower lid) approach. If there is excess skin is present on the lower lids, a small pinch technique is all that's necessary to tighten the lower lid skin. For many examples please see the link below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Tired Look?

Your eyelids contribute to making you look tired. 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 upper and lower lids: Conservatively removing the excess loose skin, 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
4.6 out of 5 stars 19 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.