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Male: What can be done about my prominent, always tired-looking eyes? I think I always had these eyes. I'm 20 now. They always look bulging, tired, and ugly. Is there something that can be done to fix this?

Dr. Amiya Prasad: Thank you for your question. You're 20 years old, and you described in your question that your eyes always look bulgy, tired, and just ugly. And of course your question is what your options are. So the photo you submitted certainly is useful. It's a little bit dark, but the overall impression, of course, is that they don't look as maybe as bad as you feel, but that's a subjective statement, and so I would ask you to consider some of the issues that when you analyze what your eyes appear in your opinion and what we can do.

First of all, 20 is relatively young, and although people in their 20's are very often very critical of their appearance, as a specialist in facial aging and cosmetic oculofacial plastic surgeon, we get to have this discussion with our patients all the time, that looking back in their 20's, they certainly feel like they looked a lot better than they thought they did at the time.

When you look at yourself, think about what are the things about your eyes that are genetic, in other words, an appearance that runs in the family, and what are the things that could potentially be the result of a lifestyle issue? For example, when patients come to us for puffy bags under the eyes - it's one of the most common reasons people come to us - and let's say they're in their 30's and 40's. They often say that their friends and co-workers will mention the bags to them and say, "Did you get enough sleep? Have you been drinking? Are you under stress?" because all of those things are associated with bags under the eyes.

So putting it in another way, you can now think to yourself, "Are there aspects in my life that may be causing my face and my eyes to look worse than they could?" Factors such as lack of sleep, smoking, environmental exposures, whether it's excess sunlight or a toxic environment. Is there stress in your life? These are the things that do affect appearance. I always tell my patients, "Look an any American president on the first day and then look at them four years later. It shows a lot in their eyes."

Now objectively just looking at your photo, the one thing I did notice is that there's a little bit of a puffy area in the inner aspect of the lower eyelids, and it looks like something called lower eyelid fat prolapse. Lower eyelid fat prolapse basically means the fat that's normally around your eyes pushes forward slightly and creates a bulge. Now, we have operated on patients as young as 14 who had significant bags under their eyes, and an example comes to mind is a young man who became very withdrawn at school because everyone thought he was on drugs, so his parents brought him in and we took care of the bags under the eyes. But when it comes to someone like yourself, you know, one of the questions that I would ask you is, "Are your eyes puffy all the time, or do you have some good days and not-so-good days?" When patients come to me and mention that there's variability in how puffy they look, I always tell them that when you have more not-so-good days and the eyes are very puffy than good days, then that's a good time to consider a procedure such as a lower eyelid blepharoplasty.

I think that being measured and careful about your decisions and not being too aggressive is very important at a younger age. You can consider some conservative options such as topical creams that are good moisturizers and things that are holistically good for you: better diet, sleep, exercise, things like that. If you feel like there is still aspects that you just can't deal with, then consulting with qualified experienced cosmetic surgeons will be of benefit, but when you are getting these opinions, just remember that the surgeries can't really be easily undone or reversed, so anything you make a decision about is something you're going to have to live with.

So a lot of times we try conservative measures first, whether it's topical creams, sometimes even injectables such as platelet rich plasma and Restylane and things like that to help improve the appearance, and the nice things about these modalities that they're not permanent, and if you don't like them or they don't agree with you, they just disappear. And so if you really want to do something more definitive that's beyond lifestyle changes, then explore these options, but again be mindful. When you're 20 years old you're still in the bloom, and your face will still continue to change over the next few years. So that being said, I hope that was helpful. I wish you the best of luck and thank you for your question.

Tired Eyes? Stop Drinking and Get More Sleep BEFORE Thinking About Surgery

Dr. Amiya Prasad discusses the causes of tired-looking eyes in a younger person, changes in lifestyle and non-surgical treatments to improve them, and why diagnosis is important before committing to surgery.