Constant Tired Expression: Why It Happens and How I Fix It
Looking tired is rarely just about lines. It is usually a mix of skin quality, hollowing, puffiness, brow or lid descent, and midface support.
The right plan treats the right layer so you look rested at rest and in motion.
By Dr. Tim Neavin • Updated
Why faces read “tired”
- Tear trough hollowing and shadowing under the eyes
- Lower lid puff from fat pads with weak support
- Upper lid skin excess that hides the crease
- Brow descent that crowds the upper lid and narrows eye aperture
- Midface deflation that removes lift under the lower eyelid
- Skin quality and pigment that dull light and deepen circles
We map light and shadow first, then decide the smallest move that changes light the most. If you are new to this approach, read my top to bottom facial analysis for fillers.
What I rule out before planning
Allergies, dry eye, poor sleep, and medication effects can worsen puff and redness. If symptoms are new or asymmetric, we may coordinate with your primary care or eye specialist before any procedure.
Non-surgical fixes
Deep structural filler for support
Small, deep placement in the midface and lid-cheek junction can lift shadow without surface puff. I avoid superficial product under thin eyelid skin.
- Best for mild troughs and early midface flattening
- Result immediate softening that refines over two to four weeks
Neuromodulator for brow shaping
Selective dosing can relax down-pullers and let the brow sit a touch higher without a frozen look.
Skin quality and pigment
Light resurfacing, skincare, and pigment control improve texture and color so lids look brighter. See injectables that help with anti-aging for how I stage these with filler.
Surgical fixes when descent or bags lead
Upper blepharoplasty
Removes extra skin and defines the crease when the upper lid is heavy. Results open the eyes and reduce makeup transfer.
Lower blepharoplasty with fat transposition
Repositions bulging fat and supports the lid-cheek junction. The goal is smooth contour without a hollow step-off.
Brow lift only when indicated
Planned for true brow descent that crowds the upper lid. I keep moves conservative to protect expression.
Midface support
Selective fat grafting or deep filler restores scaffold under the lid so results last and look natural.
Quick map from concern to first step
| You notice | Likely driver | First move |
|---|---|---|
| Dark shadow and groove under eyes | Tear trough hollowing and midface deflation | Deep structural filler to lid-cheek support |
| Bags with crepe skin | Fat pad protrusion and weak support | Lower blepharoplasty with fat transposition |
| Heavy upper lids | Dermatochalasis with or without brow descent | Upper blepharoplasty. Add subtle brow work if needed |
| Flat cheeks and early jowls | Loss of midface support and ligament laxity | Deep cheek support. Consider lift if descent leads |
What to avoid
- Surface filler under thin eyelid skin which causes puff and texture
- Over-relaxing the forehead which drops the brows
- Chasing lines instead of fixing hollowing or descent that made them
Recovery at a glance
- Filler mild swelling for a few days. Review at two to four weeks
- Upper blepharoplasty one week for social downtime. Early crease definition at two to three weeks
- Lower blepharoplasty bruising and swelling two to three weeks. Shape refines over months
FAQ
Will fillers fix dark circles
They can lift shadows from hollowing. Pigment and thin skin still need skin quality care.
Do eyelid surgeries change eye shape
The goal is a rested look that respects your natural shape. Support and careful technique protect the canthus and lower lid position.
How do you keep results natural
Small steps, deep planes, and support where light matters. We stage work and avoid surface bulk.
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Board-certified plastic surgeon with extensive experience in breast, face, and body procedures.
