Jennifer Walden, MD

Michael Breus, PhD

In today’s 24/7, high-octane society, it’s impossible not to be tired—let alone look like you could use some extra zzz’s. In fact, puffy, raccoon eyes top the list of concerns of prospective plastic surgery patients. Many injectables, creams, and full-on surgeries are designed to target tired eyes.

It’s an epidemic. At least 40 million Americans suffer from chronic, long-term sleep disorders each year, and 20 million more experience occasional sleeping problems, according to the National Institutes of Health.

And while blepharoplasty and tear-trough injections can make a difference, these interventions are much more effective when paired with good-quality sleep, says Michael Breus, PhD, a sleep specialist in private practice in Virginia Beach, Virginia, and author of several books, including Beauty Sleep.

By acknowledging sleep deprivation and seeking to identify and troubleshoot any barriers to good-quality sleep, cosmetic surgeons can help make sure patient expectations are met or even exceeded with the results of their procedure.


The two features that make patients look tired are undereye puffiness and dark circles. “Eye puffiness is a factor of undereye fat, and it is genetic,” he says.

Undereye skin is some of the thinnest on the body. It’s almost translucent. “When you are sleep-deprived, blood pools under your eyes where your skin is thinnest, creating dark circles,” he says.

“You can overcome only so much with plastic surgery,” Breus says. “You can’t fool Mother Nature. Nothing is a substitute for good sleep,” he says. But “good sleep and plastic surgery go hand in hand. There is no question about it.”

Sleep will also help improve a patient’s overall complexion. “Skin will go from ashen and pale to rosy and healthy because more sleep will boost circulation and reduce inflammation,” he says. This will enhance overall appearance, including those features that were modified via surgery.


Plastic surgeons should ask potential patients about their sleep habits during the initial consultation. This includes inquiring about how many hours of sleep they are getting each night. There is no right or wrong answer. On average, people tend to get 7 to 7.5 hours of sleep per night, but some need more and others may need less, he says.

It also helps to find out how much caffeine patients are drinking. Too much, especially late in the day, can be a red flag for sleep deprivation and/or fatigue.

Other questions include:


Learn more about sleep and sleep disorders here:

National Sleep Foundation

The Sleep Doctor Michael Breus, PhD

  • Do you feel refreshed when you wake up?
  • How many times do you hit the snooze button? “Anything more than once is too many and indicates the patient wants to stay in bed longer,” Breus says.

Plastic Surgery Practice Contributing Editor and founder of Wendy Lewis agrees that sleep habits have more of an impact on overall appearance than most of us may realize.

“Sleep deprivation causes dehydration and inflammation, and contributes to slack skin and sluggish cells,” she says. “The body is unable to operate optimally, which takes its toll on your face and tends to make you look older than your chronological age.”

Caffeine and stimulants are merely a quick fix for the underlying problem, and cosmetic procedures are not the answer. “Plastic surgeons and dermatologists can offer many effective treatments for restoring a refreshed look to the upper face, but lack of sleep factors into the long-term results that can be achieved.”

Denise Mann is the editor of Plastic Surgery Practice. She can be reached at [email protected].