Why you look tired even when you're not

People rarely arrive at a consultation asking about wrinkles. What they say is closer to "I look tired all the time", or "I don't look like myself any more". Those are not really complaints about lines. They describe a gap between how someone feels and what their face appears to be saying when it is doing nothing at all.

This post is about that gap. What causes it, what it is often not, and what can honestly be said about it.

Your resting face is not neutral

We tend to assume a face at rest is a blank page. It is not. Muscle tone, skin quality, bone structure, sleep, hydration and decades of habitual expression all shape what your face communicates before you have said anything.

The everyday version is familiar enough: people react to your face before they react to you.

That is why the comments patients report are so consistent. "Are you all right?" "You look shattered." "You looked cross in that photo." The face is sending a signal the person inside it did not intend to send.

Two muscles that pull downwards

Most people associate facial ageing with the upper face, with frown lines and crow's feet that appear when you move. The concern described above is usually about the lower face, and it is visible at rest rather than on movement.

Two muscles come up repeatedly.

• Depressor anguli oris. A small paired muscle running from the corner of the mouth down towards the jaw. Its job is to pull the mouth corners down. When it is dominant relative to the muscles that lift, the mouth corners can sit lower at rest, and a neutral face reads as sad or disapproving.
• Platysma. A broad, thin sheet of muscle covering the front of the neck and part of the lower face. As it tightens it exerts a downward pull on the jawline and can contribute to visible vertical banding in the neck.

Neither of these is a flaw. They are ordinary anatomy doing ordinary work. What changes over time is the balance between the muscles that lift and the muscles that pull down, alongside changes in skin and soft tissue.

Tiredness in the face is not always about the face

This is the part that usually gets skipped, and it matters more than the anatomy.

Looking persistently tired has plenty of causes that have nothing to do with facial muscles. Poor or broken sleep, snoring and sleep apnoea, iron deficiency, thyroid problems, long-running allergy and simple dehydration can all show in the face. So can night-time tooth grinding, which is something we do look at as part of a dental examination.

If you have been feeling exhausted as well as looking it, that is a conversation for your GP before it is a conversation about appearance. A responsible assessment starts by asking whether something else is going on, not by assuming there is a treatment for it.

What can and cannot be said about treatment

Treatment options for the lower face do exist, and the relevant ones are prescription-only medicines. That is not a technicality. It means a suitably qualified prescriber has to assess you in person and decide whether anything is appropriate for you at all, and it means UK law does not permit us to name, describe or promote those products to the public. We are not going to try.

What we can say is what this sort of approach is not. It does not lift skin. It does not replace a night's sleep or treat an underlying medical cause. It will not resolve how you feel about your appearance, and anyone suggesting otherwise is overselling. Where an intervention is appropriate at all, the sensible aim is modest.

We also decline. If the concern is skin texture rather than muscle, or if what is being asked for is a transformation, then the honest answer is that this is the wrong route.

What a consultation involves

A consultation at Sale Dental Spa is an assessment, not a sales appointment. A GDC-registered clinician will look at your face at rest and in movement, ask what specifically bothers you and when you first noticed it, go through your medical history and current medication, and talk through the options with you. Doing nothing is always one of them.

You will be told what is realistic for you. If we do not think anything here is right for you, we will say so and explain why, and if we think the answer lies with your GP we will say that too.

You can read more about Sale Beauty Spa, our aesthetics studio. To arrange a consultation, get in touch or call 0161 969 7464. We are at 77 Washway Road, Sale, Manchester M33 7TQ. You can also see our clinical team.