Why Do My Eyes Look Tired? 7 Common Causes and What Helps

People tell me all the time that they look tired, even when they’ve slept well. Usually they’re right that something has changed. But “tired eyes” isn’t one problem. It’s a handful of different ones that happen to show up in the same place, and each has a different fix. Treat the wrong one and you can spend money on something that was never going to help.

Here are the seven I see most, and how to start telling them apart.

The two-minute mirror check

Stand in front of a mirror in even light, face relaxed, looking straight ahead.

1. Look at your upper lids. Can you see the crease, or is it hidden under a fold of skin?
2. Put a fingertip just above the outer end of one eyebrow and lift it gently, a few millimetres. Does the fold above your eye mostly disappear?
3. Look at where your upper lid edge sits on the coloured part of your eye. Normally it covers just the top sliver. Is it lower than that?
4. Look under your eyes. Do you see a hollow, a bulge, a colour, or fine crinkly lines?

These are clues, not a diagnosis. More than one thing is often going on, and an in-person exam is what tells them apart. But the clues help you ask the right questions.

1. Extra upper eyelid skin (hooding)

With time, upper-lid skin loosens and stretches. It folds down over the natural crease and can sit on the lashes. Eyes look heavier and smaller, makeup smudges, and some people feel the lids are crowding their vision.

If a fold of skin hides your crease and lifting your brow doesn’t really change it, the extra skin itself is the main issue. Creams and lasers can’t remove a true fold of skin. This is where upper eyelid surgery (blepharoplasty) comes in.

2. A brow that has dropped

Sometimes the eyelid isn’t the culprit. The brow slowly descends, especially at the outer end, and pushes skin down onto the lid. If lifting your brow with a fingertip made the hooding mostly vanish, your brow is part of the story.

Mild brow heaviness can sometimes be lifted slightly with wrinkle-relaxing injections placed in the right spots. A more significant drop is a brow-lift question, which is a different operation from eyelid surgery. This matters, because removing eyelid skin alone can’t fix a low brow.

3. A drooping lid edge (ptosis)

If the edge of your upper lid sits low over the coloured part of your eye, the muscle that lifts the lid may have stretched. That’s called ptosis, and it needs a different repair from skin removal, usually by an oculoplastic surgeon.

One important note: a lid that has started to droop recently should be checked by a doctor soon. A lid that droops suddenly, especially with double vision, unequal pupils or a severe headache, needs emergency care. Don’t wait on that one.

4. Hollows under the eyes

As we age, volume under the eyes and in the upper cheek decreases. The groove between the lower lid and the cheek (the tear trough) deepens and casts a shadow. It reads as “tired” even though nothing is discoloured.

In the right person, a small amount of hyaluronic acid filler can soften the hollow. It’s one of the more technically demanding areas to treat. Swelling and irregularities can happen, and rare but serious complications involving blood vessels are possible, so not everyone is a candidate and honest assessment matters.

5. Under-eye bags

Bags are different from hollows. Persistent bags usually come from the fat that cushions the eye pushing forward, creating a bulge below the lower lid. Temporary morning puffiness is different: fluid, salt, sleep and allergies can make it come and go.

Persistent bags are a surgical question: lower-lid surgery, which is separate from upper eyelid surgery. Filler isn’t a fix for true bags and can make them look worse.

6. Crepey skin, fine lines and crow’s feet

Thin, crinkly skin on the lids and around the eyes scatters light and looks dull. Crow’s feet add lines when you smile and, over time, at rest.

For texture and fine lines, fractional laser resurfacing (CO₂ or UltraClear) can help, along with a retinoid used carefully around the eyes. For expression lines at the outer corners, wrinkle-relaxing injections are the usual option.

7. Dark circles

Dark circles come from shadows, pigment, visible blood vessels or texture, and each needs a different approach. I wrote a whole article on this, with a 10-second test to tell which type you have.

Most people have more than one

It’s common to have some hooding, a bit of brow descent and some crepey skin all at once. That’s why a good plan starts with an assessment, not a product or a procedure. Sometimes surgery is the main answer. Often it’s part of the answer. Sometimes it isn’t needed at all.

If you’d like a proper assessment of your upper lids, you can book a consultation with me. Consultations are available in English, Mandarin and Cantonese.

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