Concern · Under-eye / periorbital concerns
Why do my eyes look tired?
What you may be noticing
An under-eye area that reads as tired, hollow, discolored or puffy — sometimes more than one of these at once. "Tired eyes" is a natural way to describe all of it, but the components behind that description are frequently different from each other.
One description, several possible components
"Tired eyes" can describe very different findings.
Hollowing, pigmentation, visible vessels, skin texture, fine lines, puffiness and facial support can all contribute to how this area appears — often more than one at the same time, in the same patient.
What Dr. Lancho assesses
- Hollowing/contour
- Pigment
- Vascular visibility
- Skin thickness and texture
- Laxity
- Puffiness
- Facial support and proportions
- Previous filler or energy treatment
Clinical reasoning
The wrong component, treated confidently, can make the area look heavier.
Hollowing / volume relationship
A true volume deficiency is one possible cause of a hollow appearance — but not the only one, and treating it as if it were can add fullness where fullness wasn't the problem.
Pigmentation
Discoloration in this area has its own causes, separate from hollowing or vascular show-through, and doesn't respond to volume or vascular treatment.
Vascular show-through
Visible vessels beneath thin under-eye skin can read as discoloration or shadow, and are assessed separately from pigment itself.
Puffiness
Puffiness may be fluid-related or structural. The two don't necessarily call for the same approach, and neither is corrected by treating hollowing or pigment.
Skin quality & fine lines
Thin, textured or finely lined skin changes how the whole area reads, independent of what lies beneath it.
Facial support & proportions
Changes elsewhere in facial support can alter how the under-eye area appears in context, even when the area itself hasn't changed.
Treatment approaches
Careful diagnosis comes before any treatment decision here.
Depending on which component the assessment identifies, an approach may draw on neuromodulation where movement contributes, selected energy or remodeling treatment where skin quality is the driver, or filler — considered only where a genuine volume deficiency is confirmed, never as the default response to a tired appearance.
When combination treatment makes sense
Hollowing, pigment and skin quality can all be present in the same under-eye area at once. Where more than one genuinely contributes, Dr. Lancho may consider a staged approach, with each component given its own defined role.
What treatment can — and cannot — change
Results depend on which component is actually present, the treatment selected and individual anatomy. Treating a component that isn't the actual driver does not simply fail to help — in this area specifically, it can make the appearance heavier rather than better, which is why the assessment carries more weight here than the request.
Related treatments
Neuromodulation for movement-related change — Considered where lower-eyelid or surrounding movement contributes to the appearance.
Botulinum Toxin
Where skin quality is the driver, selected energy or remodeling treatment may be considered; where a genuine volume deficiency is confirmed on assessment, filler may be considered — never as the default answer to a tired appearance.
Before your consultation
Bring what you're seeing, not a request for filler.
This is one of the areas where an accurate diagnosis matters more than the treatment you arrive expecting. That's what the assessment is for.