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Cosmetic Dermatology Can Stifle the Comment You Look Tired

It's not what most of us want to hear: "You look tired!" Maybe it's just sympathy — but if you hear it a lot, even when you're NOT tired, you may be at your wit's end trying to figure out what to do about it.

In my cosmetic dermatology practice, I hear this complaint most often from clients who have lines around their eyes, grooves between their eyes above the bridge of the nose, or drooping upper eyelids. "Squint lines" and "frown lines" can also make people look angry when they really aren't!

These problems may be just the bad luck of heredity. One client came to me in distress about the three deep grooves between her eyes that she gets from squinting. She said she gets these from her father's side — "My dad's and aunt's grooves are so big they can hold a dime in the slots!" she told me.

For some people, the wrinkles, lines and sagging may result from the drying and damage that sun exposure does to our skin. And aging, bringing the loss of the collagen and elastin that support the delicate skin of the face, leaves it vulnerable to gravity. But whatever the cause, there are non-invasive cosmetic dermatology procedures available that can reverse these effects.

First, people most commonly turn to surgical remedies for drooping upper eyelids caused by a sagging brow. However, many can achieve satisfying results through the use of Botox. This safe and effective preparation, precision-injected into carefully-targeted forehead muscle areas, relaxes the muscle and relieves the downward pressure, effectively lifting the eyebrows and the lids below them. Many of my clients find it well worth trying this cosmetic dermatology procedure, and thereby frequently avoiding the more drastic step of surgery.

Botox also provides a great solution to frown lines between the eyebrows — the "dime-holders" my client described above. Even for those of us who manage to train ourselves not to squint or frown while awake, it's another story when we're sleeping. Sleep research photos reveal that most people give their facial muscles quite a workout while dreaming, and there's not much we can do about it! Injection of Botox into key areas of these muscles holds them in a relaxed state so they're not capable of contracting, and the skin over these muscles smoothes out.

Another cosmetic procedure that's highly effective in erasing the "tired" look is injection of a dermal filler such as Juvederm or Restylane. These gel-like products contain hyaluronic acid, a substance occurring naturally in human skin gradually depleted through time, aging and exposure to pollutants and sunlight. Hyaluronic acid binds moisture into the skin giving it volume and "plumping" it, while also stimulating natural collagen production. And collagen, you probably know, is the fibrous, elastic protein that keeps skin firm.

So, if deeply-incised grooves remain between the eyebrows and radiate from the outer corners of the eyes ("crow's feet") even after muscles are relaxed, cosmetic dermatologists will often combine Botox treatments with fillers like Juvederm or Restylane, erasing the lines and filling in the grooves.

Now, I'm not saying that cosmetic dermatology is the right answer for everyone who looks tired. In some cases of severely drooping eyelids, cosmetic surgery may be the best remedy. And sometimes the solution is simple and obvious — get more sleep! That alone is one of the best things you can do for your skin. But if you decide that cosmetic dermatology procedures might improve your tired appearance, there's one more thing you should consider.

The practice of these procedures is as much art as science; a doctor must have even more than a thorough knowledge of the fine, delicate anatomy of facial muscles. Especially with Botox, knowing exactly where to make the injection, and how much to use, is crucial. Make sure you entrust your treatment to the hands of a highly-skilled, experienced physician. You want someone who understands how to create subtle effects, avoiding that frozen look of the occasional celebrities who turn up in the media with Botox overkill or badly applied fillers.

SmoothFree Web Content, relaxed skin around your eyes erases the false impression of stress and exhaustion — so you can stop hearing "You look tired!"

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James C. Fairfield, MD, has established the oldest and most respected dermatology practice in the Delaware Valley. For more free cosmetic dermatology information and resources, and to sign up for his free report Erase the Years, visit his web site at

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