I am 36.
People comment all the time how tired I look.
What are my options?
Here are a few photos with and without makeup.
I look very tired around the eyes.
Is this something a cream, Restylane or surgical intervention could help?
Please advise, I'm ready to look awake!
Thank you for your question!
You submitted some photos without makeup and you are asking creams, Restylane or surgical
intervention can help you with looking tired.
And certainly, the photos you submitted are very helpful and you state that you’re 36
years old.
So, why do the eyes look tired?
As a practicing oculofacial plastic surgeon for over 20 years, I can tell you that in
Manhattan and Long Island, the phrase we get to hear almost every day is essentially, “I’m
tired of looking tired”.
And the reason is that the eye area really projects so much about what you feel.
And so if you puffy bags under your eyes and you have dark circles, it really communicates
fatigue, sadness and of course lack of energy.
So, what we do when we’re doing an evaluation is looking at a few things.
First of all, it is possible to have more than one issue.
Therefore you have to have more than on solution.
Currently, it’s very popular to use fillers of different kinds most in hyaluronic acid
family to help soften the transition between the puffiness underneath the eyes and the
adjacent area or the tear trough.
But’s learn first about the anatomy of what’s going on.
Let’s start with puffiness.
The puffiness is due to something called lower eyelid fat prolapse.
This means that fat pockets that are underneath that are normally around your eyes, pushes
forward and herniates and we call it herniated fat and it creates a bulge.
Now that bulge accentuates an adjacent area called the tear trough which makes it look
more hollow and creates this dynamic that makes you look like you have these deep dark
circles and you have puffy bags above it.
A lot of times, there is also volume loss in the eyelid cheek junction or an area we
call the V-deformity where there is, you know, when you are younger you have more volume
and a lot of times, genetically, weight loss or combination, you lose volume in this area.
So looking at the photos you have submitted, you could consider a combination approach
before considering surgery.
Ultimately, the puffy bags underneath the eyes need to be operated on.
You can’t treat them non-surgically.
There is no way to address the fat pockets without performing the surgery.
However, you can buy sometimes and since it’s a photo submitting, I can’t get a 3-dimensional
sense.
I can only get some degree in the sense of the shadows but a lot of times, what we have
been very successful with is a combination approach.
And a combination of using platelet-rich plasma and this is derived from your own blood.
It is using the healing growth factors necessary for wound healing and concentrating them.
We find that when we place this material from your own blood, that it is under the skin,
it creates this improvement of skin quality and then when we combine that with a filler
such as a hyaluronic acid filler like Restylane, there’s a real synergy between the two and
we get some very nice results.
It’s very important to understand that there’s an upper limit on how much volume you can
place under the eye area.
We have seen patients all the time who have had way too much filler placed in and we actually
have to dissolve that filler out using an enzyme called hyaluronidase in order to reveal
what’s going on underneath.
A lot of times, well-meaning doctors do a very artful job but they just make the cheeks
look so big that a person is almost unrecognizable because there is just too much material.
And so strategy can really be, alternative strategy I should say is, addressing the fat
pockets and then considering adding volume below the area of the fat pockets.
It’s kind of unfair reality is that you have too much volume in one area and not enough
volume in another area.
So in answering your question, for a lot of our patients, it’s a combination of surgical
treatment, filler, platelet-rich plasma and yes, topical creams to help with the superficial
issues whether it’s retinoids or good moisturizers, sunblock, etc.
We have our own skincare product line.
Certainly it helps support what we do but no skincare product can get rid of bags under
the eyes.
So I think that you have to meet with doctors and get some opinions to understand how all
of this can be handles.
You are going to see a lot of different approaches and you just to feel comfortable with the
rationale.
And for us, a lot of times, it’s an educational process.
You know a lot of people are afraid of having surgery and so, they want to first try the
non-surgical option just to learn and see if they would be satisfied.
They may not feel that they got everything they wanted done but maybe they feel they
look good enough and they’re happy before they move on to having surgery.
So there’s nothing that’s always black and white unless someone really has big bags
under their eyes then there’s no point to even discussing fillers.
But in a case like yours, there may be some rule to be a little creative.
So I hope that was helpful, I wish you the best of luck and thank you for your question!