Looking in the mirror and seeing tired eyes staring back can be a real downer. Drooping eyelids or under-eye bags can make us look way older than we are, or like we’re tired all the time. Thankfully, there are a few ways to get back that bright-eyed look.
Below, we talked with top doctors on RealSelf about the treatments available, what recovery is like, and the results we can expect.
Tired eyes’ main causes: Lifestyle and age
“The tired look can be associated with a variety of issues: bags under eyes, excess skin on the upper lids, droopy forehead and overall, the effects of loss of volume, muscle tone and the development of excess skin,” said Dr. Thomas Trevisani, an Orlando plastic surgeon.
Some of these issues can be fixed by a lifestyle change. Dr. Trevisani says that his first step in any consultation is to question his patient on their drinking, smoking and sleeping habits, “before blindly jumping into cosmetic surgery.”
Once it’s determined that this isn’t something you can fix yourself, a plastic surgeon might suggest several options. Many people are interested in a non-surgical brow lift, but doctors in this RealSelf Q&A say that this will only provide a small improvement.
“The only two ways to lift the brows without surgery is to use Botox below the brow (2 mm typical) and not in the forehead, as well as filler along the orbital bone or in the temples, if hollow,” said Dr. Richard Westreich, a New York City facial plastic surgeon, in the Q&A. “Ultimately, a brow lift result cannot be replicated without surgery, but you should have some improvement with Botox and fillers.”
What goes into an eyelid lift or brow lift
Blepharoplasty, aka an eyelid lift, can be performed on the upper and lower lids and is an excellent solution, but a brow lift may also give you the look you desire. Both procedures are going to give a smoother, more youthful appearance to your eyes.
“Hooding of the upper eyelid skin is part of the aging process of the eyelids, and that may be well suited to upper eyelid blepharoplasty,” says Dr. Eric Joseph, a New Jersey plastic surgeon. “This procedure removes that excess skin, which is almost touching your eyelashes, and hides the scar in the upper eyelid crease so that when your eyes are open, the scar is invisible.”
Age isn’t always a factor. For some people, excess skin and eye bags have been an issue for as long as they can remember — they were tired-looking 7-year-olds. On younger people, the surgery is an easy fix.
“When they are 18, you can make an incision on the inside of the eyelid and take out the fat with no scars,” says Dr. Toby Mayer, a Beverly Hills plastic surgeon. “If you are doing the surgery on an older person, you’re going to be making the incision on the outside of the eyelid because you’re going to be taking skin as well as fat.”
Dr. Mayer says that brow position is key when determining which procedure to use.
“If somebody has really good brow position, when you look at them their faces don’t really look sad, they just look older,” he says, adding that is when a blepharoplasty is appropriate. “Look in the mirror, put your hand on your forehead and lift your brows. If you like the way that looks you need a brow lift and not your upper lids done,” he says, summing it up like this: If a patient looks sad, tired or old, they need a brow lift. If they look happy but have saggy skin, they could benefit from eyelid surgery.
However, if you’ve already had an eyelid lift, a brow lift may not be an option because you don’t have enough skin around your eyes to have a lift without having that permanently “surprised” look, and you may not be able to fully close your eyes. It’s worth considering that one procedure may stop you having the other later in life.
Procedures and recovery
Regarding the eyelid lift, Dr. Joseph says, “It’s not painful. In general, there’s about seven days of downtime with this procedure. It can be performed under local anesthetic. Most patients do not require narcotics, and their pain is well managed with extra strength Tylenol.”
On the first post-op visit when stitches are removed, Dr. Joseph’s team provides and shows patients how to use hypoallergenic concealer to mask any purple bruising. “Some come in a week later more puffy than purple, and some come in more dark purple, which is more difficult to conceal, but in general a week after surgery normal social activity is resumed,” he says.
With a brow lift, Dr. Mayer says the stitches are out in six days, and you can wear makeup over the incision the day after that. “I’ve had patients who could have gone out the next night if they just wear a scarf as a fashion accessory over the hairline to hide the stitches. I tell my patients to count on a week, and it’s only 1 percent of them who need longer than that to heal,” he says.
Eyelid surgery isn’t suitable for everyone, and if you suffer from dry eye it can be a bad idea to remove any excess skin from your upper lids.
“The function of the upper eyelid is to lubricate the eye, and when too much of the eye is exposed to air it gets painful,” says Dr. Joseph. “Anybody who undergoes blepharoplasty gets some sort of scar formation, so if you have dry eye, even minor amounts of distortion on the inside of the upper eyelid due to scar tissue can exacerbate dry eye.”
Dr. Joseph recommends that patients with dry eye, or conditions such as glaucoma or thyroid issues, see an opthalmologist before considering surgery.
Tired-looking no more
Reading reviews on RealSelf, you can see that most people are thrilled with the results of their eyelid surgeries. The Worth It rating for an eyelid lift is an impressive 93 percent. One person said the results are better than she ever thought possible: “My eyes look completely natural, not pulled or tight, and I still look like me, just much better.”
Dr. Joseph says the great thing about eyelid surgeries is that they give lasting results that are often more impressive than a facelift. “I’ve stopped doing facelifts because this procedure gives better results,” he says. Dr. Trevisani says that his patients are consistently ecstatic about their final results.