Look tired all the time? What actually helps

Key takeaways

• "You look tired" is usually about a few specific features, not your whole face.
• In one study, people deprived of sleep for a night did not look measurably different, yet certain features predicted tired ratings.
• Under-eye darkness can be pigment, shadows from hollows, or visible blood vessels. Each needs a different approach.
• Heavy eyelids and low brows can make anyone look tired, at any age.
• Treat the cause. A rested look comes from small corrections, not a new face.

Why do I look tired when I am not?

I hear this a lot: "Doctor, I sleep eight hours, I feel fine, and everyone at office asks if I am unwell."

See, what happens is, people judge tiredness from a handful of cues. A 2019 study by Holding and colleagues in the Journal of Sleep Research took photographs of 181 people after a normal night or a night without sleep. Surprisingly, the sleepless group did not look measurably different. But across everyone, four features predicted that others would rate a face as tired: - Less open eyes - A downturned mouth - Darkness around the eyes - Less yellow, more pale-looking skin tone

An earlier pilot study by Akram and Barclay found faces with a lower upper eyelid were rated as looking more tired.

That is very important to understand. If your face naturally has some of these features, you will look tired regardless of sleep. The fix is to identify which ones.

Which feature is making me look tired?

Most people have two or three of these together. Basically, I look at the face at rest, smiling and from the side before saying anything.

What about dark circles?

Dark circles are one of the most common reasons for a tired look in Indian skin, and they are not all the same. - Pigment-type: brown discoloration, often running in families. Responds slowly to sunscreen, creams and sometimes peels or laser. - Vascular-type: bluish, from thin skin over blood vessels. Skin quality treatments may help a little. - Shadow-type: from a hollow under the eye, which casts a shadow in overhead light. This is a volume problem, not a colour problem.

Treating the wrong type wastes time and money. Under-eye dark circle treatment is on our skin menu, but the first step is diagnosis. Read under-eye hollows: are fillers right for you? for the shadow-type.

Can fillers help under-eye tiredness?

Sometimes, in the right person. A clinical review in the PMFA Journal notes tear troughs can be treated with hyaluronic acid fillers. But the US FDA lists the area around the eyes among areas where fillers are not FDA-approved, and the eye area carries real risk, including rare vision complications if a blood vessel is involved.

So I am careful. I use small amounts, only when the problem is clearly a hollow, and not in people with puffy bags or very thin skin where filler can make things look worse. That is your call after we have discussed it. I will tell you what I would do.

What about heavy eyelids?

If your upper lids are heavy because the brows have dropped, a small dose of anti-wrinkle injections (botulinum toxin) placed carefully can sometimes give a slight lift to the brow tail. If the eyelid skin itself is heavy, no injection fixes that, and an eyelid surgery opinion from a qualified surgeon may be the honest advice.

And here is a common trap: treating forehead lines in someone with heavy lids can make them look more tired, because the forehead muscle was holding the brows up. I wrote about this in forehead lines.

Does sleep matter at all, then?

Yes, for health and how you feel. And chronic poor sleep, stress, smoking and dehydration can affect skin over time. Our article on sleep, stress and skin ageing goes into it. But if you already sleep well and still look tired, more sleep alone will not change your anatomy.

Simple things that help skin look less tired: - Sunscreen every day, which prevents pigment and dullness - A retinoid at night for texture and tone (retinoids for anti-ageing) - Managing allergies and not rubbing your eyes - Raising your head slightly at night if you wake up puffy

What I want you to avoid

Normally, people who look tired try to fix it with more and more treatment. That often ends in a face that looks done rather than rested. Small corrections to the one or two features that matter, done slowly, are usually enough. I would rather tell you to wait than add something you do not need.

How we approach this at Dr Tvacha

At a face assessment within the Long Game Anti-ageing Plan, I look for the specific features that make your face read as tired, and explain which can be changed and how. You get a written plan, with any injectable product and dose noted and fees quoted, before treatment. Sometimes the plan is only skincare. Sometimes it is a referral for an eyelid opinion.

Written by

Dr Amit KarkhanisAesthetic Physician · MBBS, Dip. Dermatology (UK) · Reg. No. 2001/02/1124

Founder of Dr Tvacha, practising in Thane since 2005. Leads the weight loss and hair programmes.