Tired Eyes: Botox, Filler, Laser, or Blepharoplasty? How to Know What You Actually Need
“I look tired all the time—even when I’m not.”
It’s one of the most common concerns we hear from patients.
The eyes are often one of the first areas of the face to show signs of aging. Fine lines, hollowing, puffiness, loose skin, dark circles, crepey texture, and changes in the position of the brow or eyelid can all contribute to an appearance that looks tired, sad, or older than you feel.
But here’s the important part:
“Tired eyes” is not a diagnosis.
There also isn’t one treatment that fixes every aging concern around the eyes.
Botox or Dysport, PDGF, filler, laser resurfacing, prescription eye drops, medical-grade skincare, and blepharoplasty can all play a role in rejuvenating the eye area—but they address very different problems.
The key to achieving a natural-looking result is determining what is actually making your eyes look tired before deciding how to treat them.
At Denver Plastic Surgery & Aesthetics, we evaluate the entire eye area—including the brows, upper eyelids, lower eyelids, skin quality, underlying volume, and surrounding facial anatomy—to determine which treatment, or combination of treatments, makes the most sense.
First: Why Do Your Eyes Look Tired?
Several different changes can occur around the eyes as we age.
You may notice:
- Crow’s feet when you smile
- Fine or crepey skin beneath the eyes
- Sun damage or uneven pigmentation
- Dark circles
- Hollowing beneath the eyes or along the tear trough
- Puffy lower eyelid bags
- Loose or hanging upper eyelid skin
- A low or heavy brow
- A true drooping upper eyelid, known as ptosis
- A combination of several of these concerns
Two patients can both walk into our office saying, “My eyes make me look exhausted,” and need completely different treatments.
That is why we believe treatment should begin with anatomy—not with a syringe, laser, or surgery schedule.
Botox or Dysport: Best for Expression Lines Around the Eyes
If the primary concern is crow’s feet or wrinkles created by facial movement, a neurotoxin such as Botox or Dysport may be one of the simplest ways to refresh the eye area.
These treatments temporarily relax targeted muscles that repeatedly contract when we smile, squint, or make facial expressions.
Botox or Dysport may help if you notice:
- Crow’s feet at the outer corners of your eyes
- Lines that become more noticeable when you smile
- Frown lines between your brows that create a tired or angry appearance
- Certain brow-position concerns where carefully placed neurotoxin can create a subtle, more open appearance
What Botox cannot do
- Botox does not remove excess eyelid skin.
- It does not eliminate lower eyelid bags.
- It does not restore significant lost volume.
- And it cannot correct true eyelid ptosis or substantial skin laxity.
If your upper eyelids are heavy because you have significant excess skin, continuing to add Botox will not correct the underlying problem.
PDGF: One of Our Favorite Treatments for the Under-Eye Area
For patients bothered by crepey skin, fine lines, dark circles, and declining skin quality beneath the eyes, regenerative treatments have become an exciting option.
One of our favorites at Denver Plastic Surgery & Aesthetics is Ariessence Pure PDGF+.
PDGF stands for platelet-derived growth factor. Growth factors act as cellular messengers involved in healing and tissue repair. Our PDGF treatment can be injected into the under-eye area, applied with microneedling, or incorporated into treatment following certain laser procedures.
At DPSA, we particularly like PDGF for refreshing delicate, crepey under-eye skin and improving overall skin quality without simply adding volume to the area. Our regenerative-treatment protocol also uses PDGF to address fine lines and dark circles and to support healing following laser treatments.
PDGF may be a good option when you notice:
- Thin or crepey under-eye skin
- Fine lines
- Dark circles related in part to skin quality
- Early signs of under-eye aging
- A tired appearance without significant bags or excess skin
- A desire for gradual, regenerative improvement rather than added volume
Some patients see improvement after one treatment, while others benefit from a series of treatments depending on their concerns and goals.
Why we like PDGF around the eyes
The under-eye area is delicate, and more product is not always better.
Rather than trying to camouflage every under-eye concern by adding filler, regenerative treatments allow us to focus on improving the quality of the tissue itself.
That can be particularly appealing for patients who have fine, crepey skin but do not necessarily need additional volume.
Under-Eye Filler: Helpful for the Right Patient, but Not for Everyone
Sometimes the problem really is volume loss.
As facial volume changes with age, a depression can develop beneath the lower eyelid, often referred to as the tear trough. This can create a shadow that makes the eyes appear darker or more tired.
For carefully selected patients, filler may help soften the transition between the lower eyelid and cheek.
Filler may be appropriate when:
- There is true hollowing beneath the eye
- Volume loss is creating a visible shadow
- Lower eyelid bags are minimal
- Skin quality and elasticity are reasonably good
- The surrounding cheek and midface anatomy will support a natural result
Sometimes treating volume loss in the cheek or midface can also improve the appearance of the under-eye area without placing significant filler directly beneath the eye.
When filler may not be the answer
If you already have significant puffiness or prominent lower eyelid bags, adding additional volume beneath the eyes can sometimes make the area appear heavier rather than better.
The same is true when there is substantial loose or crepey skin.
This is one reason we are cautious about simply chasing under-eye concerns with filler.
There comes a point when adding additional injectable product cannot correct structural aging—and may actually move you farther away from the natural, refreshed result you wanted.
The eye area also contains delicate and important anatomy, so under-eye filler should always be approached thoughtfully and performed by an appropriately trained medical professional.
Laser Resurfacing: Best for Fine Lines, Crepey Skin, and Sun Damage
What if your biggest concern is the skin itself?
The skin around the eyes is exceptionally thin and delicate, which means changes in texture can become noticeable relatively early.
You may have:
- Fine lines beneath the eyes
- Crepey texture
- Sun damage
- Uneven pigmentation
- Rough texture
- Wrinkles that remain even when your face is relaxed
This is where laser resurfacing can be extremely effective.
At Denver Plastic Surgery & Aesthetics, our providers use customizable laser resurfacing treatments to improve skin texture, fine lines, wrinkles, and sun damage. Treatment depth and intensity can be adjusted based on the patient’s skin, degree of aging, goals, and whether laser resurfacing is performed alone or in combination with surgery.
Laser may be a good option for:
- Fine lines around the eyes
- Crepey lower eyelid skin
- Sun-damaged skin
- Uneven texture
- Certain pigmentation concerns
- Overall improvement in skin quality
Laser can also pair beautifully with regenerative treatments such as PDGF to support the skin’s healing and rejuvenation process. At DPSA, PDGF may be used following laser procedures as part of a regenerative treatment plan.
What laser cannot do
Laser resurfacing can improve the quality of the skin, but it cannot remove significant excess skin or eliminate prominent fat pads that create lower eyelid bags.
A laser can make skin smoother and firmer, but if there is simply too much skin, surgery may ultimately provide a better result.
Medical-Grade Eye Cream: Small Step, Important Role
Not every tired-eye concern requires a procedure.
A good medical-grade eye product can be an important part of both preventing and treating early signs of aging around the eyes.
At Denver Plastic Surgery & Aesthetics, two of our favorite eye products are ALASTIN Restorative Eye Complex and Revision Skincare D·E·J Eye Cream®.
ALASTIN Restorative Eye Complex
ALASTIN Restorative Eye Complex is designed to improve the appearance of fine lines, wrinkles, puffiness, dark circles, and uneven tone around the eyes. It contains ALASTIN’s TriHex Technology®, which is formulated to support healthy collagen and elastin within the skin.
We like it for patients who want a comprehensive daily eye product that targets several common concerns at once.
Revision Skincare D·E·J Eye Cream®
Revision’s D·E·J Eye Cream is another excellent option, particularly for patients concerned about fine lines, crepiness, firmness, and early eyelid hooding.
The formula is designed to treat the entire eye area and improve the appearance of crow’s feet, under-eye crepiness, elasticity, and drooping or hooded-looking upper eyelids.
What eye cream cannot do
- Even an excellent eye cream has limitations.
- Skincare cannot surgically remove excess eyelid skin.
- It cannot remove a prominent lower eyelid fat pad.
- It cannot correct significant true ptosis.
- And it cannot replace volume that has been substantially lost.
What medical-grade skincare can do is improve hydration, texture, fine lines, and the overall quality of the skin—and help protect the results of other treatments.
Think of skincare as part of the treatment plan rather than a substitute for a procedure when a structural problem exists.
Upneeq: A Nonsurgical Option for Certain Droopy Eyelids
Sometimes a patient says her upper eyelids feel heavy, but the problem is not simply extra skin.
She may have acquired ptosis, or a low-lying upper eyelid.
For appropriate adult patients, we offer Upneeq®, a prescription eye drop specifically FDA-approved to treat acquired blepharoptosis, or low-lying upper eyelids. Upneeq contains oxymetazoline hydrochloride ophthalmic solution 0.1% and is used once daily in the affected eye or eyes.
The medication temporarily activates a muscle within the upper eyelid, creating a subtle lift and a more open appearance.
Clinical studies showed an average upper eyelid lift of approximately 1 mm, with some patients experiencing visible improvement within minutes.
Upneeq may be worth considering when:
- One or both upper eyelids sit lower than they used to
- The eyes appear less open or alert
- The concern is true eyelid position rather than primarily loose skin
- A patient is looking for a nonsurgical option
What Upneeq cannot do
Upneeq does not remove loose skin.
It does not permanently correct ptosis.
It does not replace a brow lift or blepharoplasty when those procedures are anatomically indicated.
It also isn’t simply a cosmetic “eye-opening” drop for everyone. Ptosis can occasionally be associated with neurologic or orbital conditions, so a new or unexplained drooping eyelid should be properly evaluated rather than self-diagnosed. The prescribing information specifically identifies this as an important consideration.
For the right patient, however, Upneeq can be a very nice nonsurgical option.
Blepharoplasty: When the Problem Is Excess Skin or Eyelid Bags
Sometimes the right answer really is surgery.
Blepharoplasty, commonly called an eyelid lift, can be performed on the upper eyelids, lower eyelids, or both.
At Denver Plastic Surgery & Aesthetics, Dr. Christine Rodgers and Dr. Cecelia Nguyen perform eyelid surgery to address concerns including excess upper eyelid skin, droopiness, and bags beneath the eyes. Upper and lower eyelid procedures may be performed separately or together depending on the patient’s anatomy and goals.
Upper blepharoplasty may be appropriate if you have:
- Excess skin folding over the upper eyelid
- Loss of a defined upper eyelid crease
- Difficulty applying eye makeup because of excess skin
- Significant heaviness around the upper eyes
- Upper eyelid skin that interferes with vision
Lower blepharoplasty may be appropriate if you have:
- Persistent bags beneath the eyes
- Bulging lower eyelid fat
- Excess lower eyelid skin
- A tired appearance that remains regardless of sleep, skincare, or nonsurgical treatment
Blepharoplasty treats the structural problem rather than trying to camouflage it.
For the right patient, surgery may actually produce a cleaner and more natural result than repeatedly attempting to treat significant skin excess or prominent bags with nonsurgical procedures.
Sometimes It Isn’t Actually Your Eyelids
The upper eyelids do not exist in isolation.
A lowered or heavy brow can contribute significantly to hooding over the upper eyelids.
In those patients, simply removing eyelid skin may not completely address what is making the eyes look heavy.
A brow lift raises the eyebrow to a more youthful position and may be performed independently or together with blepharoplasty when aging involves both the brow and eyelid. Our surgeons evaluate both structures during consultation rather than assuming every heavy upper eyelid is strictly an eyelid problem.
There is also an important difference between:
- Excess upper eyelid skin
- A low eyebrow
- True eyelid ptosis
They can look similar to a patient looking in the mirror, but the appropriate treatments are very different.
Do You Have to Choose Just One Treatment?
Not necessarily.
In fact, some of the most natural results come from addressing different layers of aging with different treatments.
For example:
Blepharoplasty + laser resurfacing
Blepharoplasty addresses excess skin and structural aging, while laser resurfacing improves fine lines, texture, and skin quality.
Laser + PDGF
Laser stimulates skin remodeling while PDGF can be incorporated to support healing and regenerative improvement.
Botox or Dysport + laser
Neurotoxin softens wrinkles caused by repetitive muscle movement while laser treats damage and fine lines within the skin itself.
PDGF + medical-grade skincare
PDGF can improve under-eye skin quality from within while a consistent home regimen helps support and maintain the skin between treatments.
Blepharoplasty + Botox or Dysport
Surgery addresses excess skin while neurotoxin continues to soften crow’s feet and other expression lines.
Filler + regenerative treatment
For carefully selected patients with both true volume loss and declining skin quality, subtle filler and PDGF may address two different components of under-eye aging.
Upneeq + skincare or other nonsurgical treatment
For patients with mild acquired eyelid ptosis plus skin-quality concerns, different treatments may address each issue independently.
The goal is not to do more.
The goal is to determine what is actually causing the problem and treat only what needs to be treated.
A Quick Guide: What Might Be Making Your Eyes Look Tired?
Crow’s feet when smiling:
Botox or Dysport may be appropriate.
Thin, crepey under-eye skin or fine lines:
PDGF, laser resurfacing, medical-grade skincare, or a combination may be recommended.
Dark circles:
First determine the cause. Skin quality, pigmentation, visible vessels, hollowing, and shadows can all contribute. PDGF, skincare, laser, or carefully selected volume restoration may be considered depending on the anatomy.
True under-eye hollowing:
Carefully selected filler or another regenerative approach may be considered.
Sun damage or uneven texture:
Laser resurfacing and medical-grade skincare may be appropriate.
Mild low-lying upper eyelid from acquired ptosis:
Upneeq may be an option for appropriate patients.
Heavy upper eyelid skin:
Upper blepharoplasty may provide the most meaningful improvement.
Prominent lower eyelid bags:
Lower blepharoplasty may be more appropriate than repeatedly adding filler.
Low or heavy brows:
A brow lift may need to be considered in addition to—or instead of—eyelid surgery.
Several of the above:
A combination approach will often provide the most balanced result.
Why We Don’t Believe in Chasing Every Problem With Filler
Nonsurgical treatments have transformed aesthetic medicine. Botox and Dysport, filler, PDGF and other regenerative treatments, lasers, prescription skincare, and newer options such as Upneeq allow us to treat many eye-area concerns without surgery.
But nonsurgical does not automatically mean better.
And injectable does not automatically mean filler.
As our faces age, there may eventually be structural changes that adding volume simply cannot correct.
If someone has significant upper eyelid skin or prominent lower eyelid bags, repeatedly adding product in an attempt to disguise the problem can become expensive—and may not create the refreshed appearance the patient is looking for.
Likewise, a patient whose main problem is crepey skin may benefit more from improving skin quality with PDGF, laser resurfacing, or excellent medical-grade skincare than from adding volume she does not actually need.
Sometimes doing less filler and choosing the right treatment produces the more natural result.
That doesn’t mean every patient with tired eyes needs surgery.
It means the treatment should match the anatomy.
How Do You Know What You Actually Need?
Start with the concern—not the treatment.
Instead of coming in saying:
“I need under-eye filler.”
“I need Botox.”
“I need my eyelids done.”
Tell us what you actually see:
“I always look tired.”
Then let an experienced provider evaluate why.
At Denver Plastic Surgery & Aesthetics, our surgical and medical aesthetics teams work together to evaluate the entire eye area rather than treating one isolated feature.
For one patient, a few carefully placed units of neurotoxin and a good eye cream may be enough.
Another may benefit from PDGF to improve crepey under-eye skin.
Someone with acquired ptosis may be a candidate for Upneeq.
Another patient may have true volume loss that warrants carefully placed filler.
And for someone with significant excess skin or lower eyelid bags, blepharoplasty may ultimately provide the most natural and lasting improvement.
Our goal is never to make you look like you’ve had something done.
It’s to help you look rested, refreshed, and like yourself.
Tired of Looking Tired?
If you’re bothered by tired-looking eyes, dark circles, crepey skin, under-eye hollows, eyelid bags, or heavy upper lids, we can help determine what is actually causing the concern.
Denver Plastic Surgery & Aesthetics offers surgical and nonsurgical options including Botox and Dysport, PDGF regenerative treatments, dermal filler, laser skin resurfacing, medical-grade skincare from ALASTIN and Revision Skincare, prescription Upneeq, and upper and lower blepharoplasty.
Schedule a consultation with our team to create a personalized treatment plan based on your anatomy, concerns, and goals.
Because when it comes to the eyes, the best treatment isn’t necessarily the newest or most aggressive one. It’s the one that treats the right problem.
