Why do my under-eyes look tired even when I’m not?
“I look tired all the time” is one of the most common things people say to me when we start talking about their under-eyes.
And unfortunately, getting eight hours of sleep does not always fix it.
The under-eye area is complicated. Darkness, hollowness, fine lines, pigmentation, visible blood vessels, puffiness and changes in skin quality can all create a tired appearance — and they do not all respond to the same treatment.
That is why treating under-eyes properly starts with working out what is actually causing the problem.
Hollowness and shadowing
Some people naturally have a deeper tear trough or lose volume around the eye as they age.
When there is a hollow between the lower eyelid and cheek, overhead light creates a shadow. That shadow can look like a dark circle even when the skin itself is not particularly pigmented.
Volume loss elsewhere in the mid-face can sometimes make this more noticeable too.
This is very different from true pigmentation and needs to be assessed differently.
Thin skin and visible vessels
The skin underneath the eyes is naturally very thin.
In some people, the underlying blood vessels and tissues show through more prominently, giving the area a blue, purple or grey appearance.
As collagen and skin quality change with age, this can become more noticeable.
Treatments designed to improve skin quality may be more appropriate here than simply trying to add volume.
Pigmentation
True brown pigmentation around the eyes can be genetic, related to sun exposure or sometimes worsened by inflammation and rubbing.
If pigmentation is the main cause of the darkness, filling a hollow will not fix it.
This is where skincare, sun protection and carefully selected skin treatments become much more important.
Fine lines and crepey skin
The under-eye area moves constantly.
We blink, smile and squint thousands of times a day, and the skin here is thinner than almost anywhere else on the face.
With time, it can become finer, drier and more crepey.
For these patients, improving hydration, collagen stimulation and general skin quality may be more useful than adding volume.
Puffiness and eye bags
This one is particularly important because not every under-eye concern is suitable for injectable treatment.
Prominent fat pads or significant puffiness can sometimes be made more obvious by adding volume nearby.
If somebody has true eye bags, I would much rather explain that a particular treatment is unlikely to help than perform something simply because it is available.
In some cases, surgical assessment is the more appropriate option.
So what actually works?
It depends entirely on what we are treating.
Options may include:
prescription or medical-grade skincare where appropriate
diligent SPF
treatments aimed at improving skin quality and collagen
polynucleotide treatments
carefully selected dermal filler in suitable patients
treatment of the cheek or mid-face rather than directly underneath the eye
or no injectable treatment at all
Often it is a combination.
Under-eye treatment in Alderley Edge
At DR JACKSON SKIN in Alderley Edge, I assess the whole under-eye and mid-face area before recommending treatment.
The aim isn't simply to “fill the tear trough”. It is to work out why somebody looks tired and choose a treatment that actually addresses that problem.
If tired-looking eyes are something that bothers you, a consultation is the best place to start.