Congested / Tired / Puffy looking eyes ever since I can remember - I am now 29 (Photo)

As far back as I can remember, I have always suffered with puffy tired looking eyes. Not only do they make me look tired and aged but I can actually feel under my eye area to be quite congested and irritable. I suffer from hayfever however, my eyes are bad regardless of the season, how much sleep I get or how much water I drink. Some days my eyes are better or worse however I cannot identify the pattern. Lymphatic drainage appears to help temporarily to relieve the congestion.

Doctor Answers 5

Rejuvenating under the eye--lasers, microneedling/prp and fillers

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There are many options that can help this. First, it's important to have your allergies under control. Then, a combination approach would be best. Fillers, lasers, and microneedling/PRP can improve under eye hollows. 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.

Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

Options for under eye area

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There are options for you to consider depending on how aggressive you want to be with treatment.  The first step is to get your allergies under control the best that you can.  Next you can consider using filler to soften the hollows under the eyes leaving a smoother overall appearance.  This is a temporary fix and will generally last 9-12 months.  If you want a more permanent result you can consider lower blepharoplasty surgery which will surgically correct the under eye area.  See a board certified plastic surgeon in your area to learn more.

Camille Cash, MD
Houston Plastic Surgeon
4.9 out of 5 stars 36 reviews

Lower lid fat pads

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You have some prominent lower lid fat pads.  When these swell with your allergies, they will appear larger and create more darkness in the lower lid. 

You can put some HA filler in below the fat, into the tear trough which will help smooth out the are and make the fat less noticeable.   Your other option is a lower eyelid blepharoplasty.  I like to do a transconjunctival approach and do a fat repositioning, whereby the fat is moved down into the tear trough.  I think this creates a better contour and helps with the dark shadows more than taking out the fat.    

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 31 reviews

Tired eyes in the young

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There are many causes of eye bags. Some are shadow issues, some are discoloration issues.  

1. Prolapsed orbital fat through the orbital septum (less likely in young people): treated with lower lid blepharoplasty and fat re-positioning. Can also be helped with fillers or auto fat transfer to the face but the ideal treatment in my hands is surgery for this issue.

2. Ezcema/lower lid manipulation: much more common in young people with fair skin. I believe this is your issue. The treatment for this is to hold off on creams and manipulation of the lower lid for a few weeks and try some topical anti inflammatory creams. If you have allergies those should be treated also.  A dermatologist is the best person to see for this. We have a multidisciplinary clinic with myself, a plastic surgeon, and my partner, a dermatologist which I think is ideal!

3. Fluid accumulation and/or redundant skin. You said lymphatic drainage helps? Try a warm compress if this helps then possibly there are some treatments we could offer. Could be possible in young patients but would need a good facial analysis and exam to determine. I would treat with filler/fat transfer, lower lid fractional ablative laser and/or lower lid blepharoplasty.

4. Descent of midface cheek pad. This then causes the nasojugular ligament to become more prominent creating a demarcation and separation of the eye from the cheek subunit. Unlikely in your case but can happen. Treated with mid face lift and fat transfer.

It is all about the balance of this transition from the orbit to the cheek. There are many ways to treat this and they vary by the underlying cause. I recommend seeing a surgeon who also does a lot of these treatments. This can make a big difference as most people have a combination of the above that lead to the issue.

Hope this helps.

Best of luck,


Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Tear trough hollowing or dark circles

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Thank you for the super clear photos, that really helps. 

Firstly this does not require surgery.

What you have are tear troughs or under eye dark circles. The little bulges are of your normal fat and the best way to make your under eye area look more refreshed, is to have TearFill or hyaluronate gel (Restylane filler) introduced into the area. 

This is done by an oculoplastic surgeon with experience in fillers into the periorbital area. It involves having a small entry needle point on each upper cheek (with local anaesthetic) through which a very fine canula is introduced to reach the tear trough area. This will refresh the area and make you look less tired.. 

Jane Olver, MBBS, FRCS
London Oculoplastic Surgeon
4.3 out of 5 stars 6 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.