In this episode of The Beauty Equation Podcast, Dr. Christelle Oliver-Dussault, Dr. Harpreet Lotay, and Amanda Manholt unpack the question many people ask themselves: “Why do I look tired?” They explore the anatomy and aging processes that contribute to a fatigued appearance—from volume loss in the cheeks and temples to changes in skin tone and elasticity. The hosts explain why under-eye shadows aren’t always about lack of sleep and how factors like pigmentation, bone structure, and even allergies can play a role. They emphasize understanding the root cause before choosing treatments, highlighting personalized care, natural results, and the emotional connection between how we feel and how we appear. With humor and honesty, the conversation reminds listeners that beauty is about harmony, not perfection—and that sometimes, the best fix starts with a deeper look beneath the surface.

Disclaimer: The Beauty Equation is for informational purposes only and not medical advice. This podcast does not create a doctor–patient relationship. Always consult a qualified healthcare provider before making medical or aesthetic decisions. Information may change as the field evolves.

Thanks for listening!

Thanks so much for listening to our podcast! If you enjoyed this episode and think that others could benefit from listening, please share it using the social media buttons on this page.

Do you have some feedback or questions about this episode? Leave a comment in the section below!

Subscribe to the podcast

If you would like to get automatic updates of new podcast episodes, you can subscribe to the podcast on Apple Podcasts or on your favourite podcast app. 

Leave us an Apple Podcasts review

Ratings and reviews from our listeners are extremely valuable to us and greatly appreciated. They help our podcast rank higher on Apple Podcasts, which exposes our show to more awesome listeners like you. If you have a minute, please leave an honest review.

About the Hosts:

Dr. Harpreet Lotay is a family physician specializing in aesthetic medicine. She is the founder of Sona MD in Kamloops, BC, and serves as Chief Medical Officer at Bios Wellness Clinics. Known for her artistic approach and comprehensive non-surgical treatments, Dr. Lotay combines medical expertise with an eye for natural results. She is also an educator, a national trainer and holds academic appointments where she shares her knowledge in clinical dermatology and aesthetics. You can get in touch with her on Instagram @hlotaymd

Dr. Christelle Oliver-Dussault is a family physician specializing in aesthetic medicine, women’s health, and psycho-education. She brings a holistic, whole-person perspective to her clinical work, blending science with a deep understanding of the mind-body connection.

She is also the founder of Reclaim The Pink Within, a movement that empowers women to rediscover themselves during life’s most transformative stages. In addition, she is passionate about medical education and mentors the next generation of family physicians through her work with the department of Family Medicine at the University of British Columbia.

You can connect with her on Instagram @drchristellemd

Amanda Manholt is a clinic manager, patient consultant, and co-host of The Beauty Equation Podcast. With over 30 years of experience in beauty, aesthetics, and leadership, she has guided patients and teams alike toward confidence, growth, and empowerment. Known for her ability to connect with people and simplify the often-overwhelming world of aesthetics, Amanda brings a warm, practical, and relatable perspective to every conversation. You can find her on Instagram @crowsfeetandconfidence.

Websites

https://sonamd.ca/

https://www.getyourpinkbackproject.com/

If you start at the deepest layer, your bone, as you get older,

your orbit, so the eye socket actually enlarges. And then if

you move a little way up, then we have all those cushions. Those cushions, when

you see in a baby or a teenager, like you mentioned, Harpreet, that offer

that fullness. And we really notice that, like you said, in the mid cheek and

also in the temples. And oftentimes that's one that

is harder for people to understand because it's above the eye,

it's not underneath it. Yet. We. When you replenish the volume there,

all of a sudden the under eye does start to look brighter.

And then if you address the cheek area where you would previously have had

because of the bit of that sunkenness and the loss of fat, that

like dark line goes all the way down. And it's okay to have a bit

of darkness close around the eye, but if it keeps going down, that what's,

that's what gives you that drawn and tired look. And then there's

ligaments that come into play. And also the skin too, not

the dark circles aren't all always, you know, because of

a thin skin or the hue. Sometimes it's pigmentation. That can happen in pregnancy as

well. So it's a very complex area and there's lots of

different ways we can address it based on the

reason why you have that appearance of being tired.

Welcome back to the beauty equation. I'm Dr. Christelle Oliver Dusseau.

And I'm Dr. Harpreet Lotte. And I'm Amanda

Manholt. Today we're going to be switching gears a little bit and talking about

certain common appearances that we all experience and how they affect us.

Have you ever had a really good night's sleep feeling rested and

energized and then you walk into work and one of your colleague looks at you

and. Says, you look tired. Are you feeling

okay? That comment stings so much,

especially when you feel rested. I don't know why people

feel the need. Right. Honestly, why,

why, why do people have to say those things? But I had it today in

a consult. It's. I. It's so common. People are like, I just feel

like I look so tired all the time. Even if I've slept, I don't

know what's going on. Yeah, it's unfair because

some of these changes are just associated with how humans

age. And we'll get into that a little bit later. But you're right, those comments

hurt. One of the reasons that it can be really impactful for people I

find especially as you get older, you know, in your

40s or maybe 50s, is oftentimes women in

those age groups are really reaching the top of their careers. They're very

accomplish, they feel very good about their capacity and their

capability, but oftentimes their face doesn't really reflect that

vitality and they become really concerned that they're going to be judged as

maybe less capable or less able to

perform those high achieving sort

of jobs that they're in. And so that actually becomes

a concern later on in their careers. I don't know if you've seen that, Amanda.

Yeah, I think it, it speaks to relevance. Totally.

I remember one woman we had in a few years back and she

was, she was sort of, you know, she wasn't ready to retire, but she'd certainly

had way more years in than all of the junior staff. But

she felt like she was invisible. So, you know,

that, that is definitely a thing. I'm, I am tired.

I just don't want to look tired. I mean, that's my thing.

And I think we get that a lot. As you enter kind of perimenopause and

menopause, there's so many changes that happen to your mind and your body.

And you know, in my time in general practice, that's such a

common complaint that I would get and I still get is just I feel really

tired, I feel off, I don't feel like myself. And while you know,

you're working on those things yourself through lifestyle and sometimes you need

medication, sometimes you want your appearance, you almost want to

fake it until you make it. And then other times you've done all that work

and you feel great and yet that's not reflected on the outside. And that's where

we come in. Absolutely. Yeah. And I

think it's probably in terms of, you know, if you think about age,

like 30 year olds, 40 year olds, 50 year olds, 60 year olds,

I don't know, I feel like that one is the tired aspect.

I feel like it's one we hear earlier. Like, you know,

people in their 30s. Noticed in myself and would say

that's probably one of the things that bothered me the most, especially after having children

because those early years you're very, is sleep deprived and there's

just no amount of makeup that is going to fix those dark

circle and that drained look. And even as you recover,

it just seems like there are certain changes that happen after your pregnancies

where your anatomy is slightly different and

you just can never get that refreshed look. Even when your Baby starts to

sleep again and they're sleeping through the night and that can be really

frustrating. Yeah, it is one of the earliest areas

that we start to see changes physiologically. You know, we start

to see that sort of loss of mid face

fat volume. So if you think about a, you know, a

16 year old human, they have nice full

cheeks, you know, so the next time you see a teenager, just take a

look, they have fat pads that go all the way up to their orbital rim

and super full. And that starts to thin out and

they start to look mature and, you know, more

adult, like in their 20s and then into their

mid-20s and, you know, so that loss

of mid face fat volume really contributes to

that look of tiredness because you start to see that orbital

run the edge of it as that fat regresses.

And I find it kind of interesting from an aesthetics perspective

because you have these 18 year olds who will come in for fat filler

and they'll come in for augmentation and enhancement.

And one of the things that I've noticed is oftentimes those

young people will get aesthetic treatments and they will

end up looking older. And they're almost gunning for

that and wanting to do that. And there's some subtle anatomical

reasons why. And we can't get into that in other

episodes. But that mid cheek area is a real

signal or for age. And then tiredness, like you

mentioned. And that 30 year sort of benchmark is really common

where people will come in and start to notice hollowing. They'll say

hollowing, they'll use words like dark circles. They'll say

things like sunken. So it's kind of how we age.

And I think to your point, Christel, where you've gone

through pregnancy, you've had, you know, you've had sleep deprivation

and having those signs that are there, that are accelerated

by stress, sleeplessness, cortisol

changes. You don't want to see it in the mirror because it's almost

like ptsd. You're like, I don't want to be reminded of that time.

I'm over it. You know what? That is so true.

Oftentimes women come in to see me and they have

had some major shift in their life. Whether

they perhaps have a marriage that's ended or

they've been caring for their parent that's, you know,

ailing. They kind of come through something and then they

say to me, I look in the mirror and all I

see is the exhaustion I felt at that

period of time in my life, or the sadness or the rage right

so yeah, I think emotional attributes are quite fascinating and,

and you know, if we've, it's what

I love about what, what you guys both do. I think when, when people get

sort of hyper fixated on a particular line, a

particular shadow and you know, they're

trying to guide their practitioner to just address that one

little issue, it often doesn't solve the problem. And

the really the problem is, is they don't want to look tired.

Right? Yeah. But they don't really necessarily understand the emotion,

emotional attributes of, of that.

Right, yeah. And there's so many changes that happen there. So if

you start at the deepest layer, your bone, as you get older,

your orbit, so the eye socket actually enlarges so

there is more room for things to sink. And then if you move a

little way up, then we have all those cushions, those cushions when you see in

a baby or a teenager, like you mentioned harpreet, that offer that

fullness and we really notice that like you said in the mid cheek and also

in the temples and oftentimes that's one that is harder

for people to understand because it's above the eye,

it's not underneath it yet. When you replenish the volume there,

all of a sudden the under eye does start to look brighter.

And then if you address the cheek area where you would previously have had

because of the bit of that sunkenness and the loss, the fat, that

like dark line goes all the way down and it's okay to have a bit

of darkness close around the eye but if it keeps going down that what's,

that's what gives you that drawn and tired look.

And then there's ligaments that come into play and also the skin too,

not at the dark circles aren't always,

you know, because of a thin skin or the hue, sometimes it's pigmentation that can

happen in pregnancy as well. So it's a very complex area

and there's lots of different ways we can address

it based on the reason why you

have that appearance of being tired. Yeah, I think the

assessment to your point, it really is so important. Right. So

a lot of people will go and buy all these eye brighteners

and all these sort of, you know, filters,

filter powders and things that are reflective and

early on when you start to see some of those anatomical changes that

will certainly help and blur the area. But

at some point people will notice it's not really doing the trick. Their concealer

really isn't working. That blur stick thing isn't really working.

And it's because you're either seeing advanced skin

changes where you've got creepiness and wrinkling and that

alone, that skin change, the wrinkliness can add to the appearance

of tiredness. And then,

you know, it could be volume loss in and of itself,

that cheek fat going away and no amount of

blurring is going to take away a divot. Right?

So that, that's, that's the other thing. So

assessing is it the skin that's contributing? Is it the

volume that's contributing, whether it be in the temple or in the

mid face, or does the person truly have

volume loss in the tear trough will really dictate what's going

to work best for that person. I

like the little thing that you taught

me to do is where if they've got their hair like,

okay, let's face it, I have gone back to bangs. I used to say it's

bangs or botox. Now I say it's both. Because I

naturally, luckily enough,

have a pear shaped head which matches my pear shaped body.

And the natural shape of my skull is

smaller and in this area here. And

you know, it is one of those areas where we can address with filler. I

think it's trickier on someone with my anatomy, for example.

So yes, we can do a little bit of volume in the, you know, this

anterior part of the temple, but I could also just put my hair over

top and then, you know, it adds some volume here

and I find it just can hopefully look better.

Amanda's referring to, for people who are listening on the podcast, is

the temple area or the area just beside your

eyebrow can get kind of deeper. And so

sometimes that's described as peanut head. So if you think about the

planter's peanut guy, so that shape is how we naturally

age. And that sort of divot that happens just next to your

eyebrow can be distracting to the eye. And a lot of people don't realize that

that is contributing to their look of tiredness, like Christel said.

So oftentimes when we're assessing people's photos, we'll just cover

that area up. And you can do that yourself at home by just bringing your

hair forward and ask yourself, do I look better with my hair forward?

And if so, then the temples could be contributing to that look of

tired or not just like looking older. And I would say temple

volume loss actually contributes to the look of looking a little

older even more than looking tired. And that's actually

why when younger people get the supermodel look with the

cheekbones augmented, it will make it look like

you have volume loss in the temple because there's

a little bit of a change in, you know, relative

volume. Even though they don't have any temporal volume loss, they can look

older. So all these little subtle things that the human

eye picks up are really,

they're really impactful. So yeah, you can bring your

hair forward and cover the temple area up and just ask yourself, do I look

better? And that could tell you if temple filler is an option for

you or not. Yeah, yeah. And, and I think certain

in. And all of these things we talk about are sort of in general

terms. But it's interesting because you'll see somebody that

is, you know, they could both be 40 years old. Two, two people

that are 40 and one person can just naturally

have that very flat mid face. Yes. Right.

Whereas somebody else could have much. Oh. And

you know, I, I probably felt the best at

about 35 because in my, we all have fat

cheeks in my family. So I had started to lose some facial

volume. I didn't really understand it, I, at the time because I wasn't doing

this kind of work. And I remember thinking I got a little.

Oh, wow, look at that. Then it all.

Chicken cheeks are gone. I used to have them. Yeah, yeah. And

to your point, Harpreet, you were talking about these younger girls,

like the sort of, we call them, say beautifiers that are looking to,

you know, improve certain aspects. There's

been some over the years where they come in and they don't like being

cute. No, they want to look sexy. They want

to be sexy and they. Want to look grown up. Yes. Yeah. I often think

of like Bella Hadid, when you look at her transformation,

you can really see how she went from having that younger 20 year old face

to that elevated cheekbone look. So we keep going back

to younger people trying to look older, but we're

wanting to focus on the tired look. So we talked about the volume loss around

the temple, the synthetize and fillers.

But in terms of addressing the skin

quality and trying to determine

pigmentation versus hollowness, what are some tricks

that we. Could give to people? Harper. So there's,

you can check in about three seconds. So

if you take a look at the area that you consider dark,

just take your finger and just put it

underneath the area and retract the skin down. Try to move

the skin and if the pigment or darkness that you're seeing

moves with it, that means the darkness or pigment

is in the skin itself. And so at that point we need to treat

the skin with things like Kojic acid,

mild retinols, things like that, Vitamin C to help

the skin pigment. And you can also use

lasers to help the skin and you can try to

thicken the skin up and get it to turn over a little bit more to

release the pigment. If the pigment is bluish

and it doesn't really move with the skin, then it

could be venous stasis and that is

a structural issue. And you can sometimes help

that by thickening up the skin itself using growth factors,

maybe some prp. And PRP can be helpful with

pigmentation that's within the skin as well. So those

issues are different than volume loss. So if you move the skin

and you still see some hollowing and there's, it's almost like a

linear hollowing and you can see kind of a divot that's volume loss.

And it could be true tear trough deformity.

It's not a deformity, but that could be how your tear trough is structured.

And you might benefit from filler,

small amounts done judiciously. So those are a

few tips and tricks if you're self assessing. Thankfully there's

less people coming in going, I want my tear troughs treated.

You know, it was quite popular, I'd say

five years ago, but it's

probably one of the last things that we ever do. Yeah,

I'm going to let Christelle speak to that. So when someone comes in and

you're thinking, I want to do their tear trough, tell me a

little bit about how you approach it and what you think about when you decide.

So the tear trough, as Amanda was saying, it is really tricky and the reason

why we do it last is because if you put too much volume

in there or it's not true volume deficit,

you're going to end up looking puffy. So you're going to have a puffy under

eye, which is another thing that can happen as you get older and makes you

look more tired. So that's the last thing we want to do. And that goes

back to again addressing the volume around the temples and the mid

cheek and sometimes that's enough and you don't need to do anymore.

And if then we do need to replace a little bit of volume, we can,

but often we'll under treat just because of that risk, because

if we're putting something there, we all have

lymph that goes around our face or bodies and it naturally drains.

But if you have too much filler in there, it can block the drainage.

So increase that puffiness. So be particularly

careful around people who have a lot of allergies. So, like seasonal allergies or prone

to swelling in their eyes, that's just a little bit of a red flag that

we may actually make that worse. And then in which case we have other

modalities. Like Dr. Lotte mentioned, the PRP. So

what PRP is, is we take your own blood

and we extract the plasma, which has all those growth factors. So that

will help stimulate your collagen, thicken the skin so the quality will be better,

and then you won't have that hue and that volume deficit won't be as

noticeable. Lasers, as you mentioned, or sometimes things like

radio frequency microneedling can help. So there are a lot of

tools and it often takes different approaches and multiple visits

to get to address that tired eye

look of them. Less is more in that area, for sure,

as you mentioned. And the other caveat,

I would say is that oftentimes when we start to look at an

area, it's not uncommon for patients to get really fixated on

completely obliterating a contour.

Yeah. And I can't stress enough that it's

very natural to have contours in certain areas,

and it's important to preserve that so that you look natural

and not to fixate on just that contour. Just

like Amanda was mentioning, like, we're not here to make the line go away

necessarily. We're here to make you look more beautiful and refreshed

and more like who you are. So, yeah,

those contours are important for light. Light

and shadow looks beautiful. You know, when we're

looking at art and painting, contrast looks beautiful.

Don't get rid of it for sure.

Almost like. I was just. No, I was also

thinking about the. It's interesting when people have had

allergies for a long time, the majority of their life,

it's. You can almost pick them out. Once you start to get good at assessing

faces, you know, there is that quality

to the skin around the eye that is. Tends

to be a little duller, a little creepier, almost a little bit more compromised. And

I don't know if it's because they've rubbed their eyes so much or if they've

had this constant, you know, expansion and

contraction of. With the swelling. Yeah. The eyes are such

a very complex thing, so skin

as well, is going to have an impact too, on reflectivity of light.

I feel like we could do an entire episode on the eyes.

It's so complex. And this is really just a little taster

to make you understand that if you're seeing something Be

prepared to have a discussion about other areas of your face and how they're

impacting that. There are multiple tools, and based

on your ethnicity, your bone

structure, your medical history, we're going to change the

way that we approach that. And really, if you

looked hard, it's information. It's not necessarily a flaw.

It's telling us regarding some changes that are happening.

And if you're feeling finally rested and you want to

match the inside, we can do that. If you're

absolutely exhausted and you want to fake it till you make it,

we can do that as well. And if you walk into work and

someone looks tired, don't say, gee, you look tired today, because that's

just rude. Tips for keeping friends 101.

Yeah, exactly. Don't be a jerk. Yeah.

Anything else you guys want to add to the looking tired

episode? I just wanted to

say, like, is there any other aspects

of the face besides sort of the cheek and

the eyes where you feel like tired ever comes into play,

or is that always different? Different attributes, typically, for example,

in the lower part of the face. Yeah, you know what? I think tired is

pretty much an upper and mid face. I would. I would

challenge that. And I would say skin.

Yes, yes, yes, yes, yes.

The tone of the skin, the color of the skin not being uniform.

To me, reeds is tired when the skin is mottled and

dirty. Yes. And you know what? That really speaks to

understanding what your patient is saying too. So that really brings to mind a

patient that we had that you had a conversation with Amanda,

and she kept saying, I look tired, I look tired. And when we did the

assessment with her, and we did our usual techniques of

trying to understand by covering parts of her face and looking at her

anatomy, and she did have mid face volume loss. She did have a little bit

of temple volume loss, but she didn't see it. And I. We

felt like we were sort of talking around each other in. In the

conversation, and then finally sort of said to her, like,

why don't we fix your skin? Because she had lots of

irregular pigmentation, she had dullness, she had sun damage.

But because she couldn't really see some of the structural things we were

pointing out, filler may not have made her feel better or

made her feel less tired. And I think that's key. It's

important to make sure your patient is seeing what you're seeing so that

your recommendation is going to make them happier, because that's really what

we're here for. So we did a halo and a

BBL and she was so happy. Over the moon. That made

her feel like she looked less tired. And to your point, Amanda, she did.

So, yeah, I agree. So like I said,

it isn't one size fits all. So everybody's

anatomy is different. And to your point, what people see

is different too. And I mean, sometimes I just want to go, oh my God,

you need a chin so bad. But I don't. Because if they

don't see it, I'm not here to point out things that

don't bother people. No. And our job is to understand the one thing

that's watering the most. So to your point, that's what's going to make

her feel better. She was seeing actually more the uniform

dullness and irregularities in her skin, and she wanted that brightness

back. And she would have spent a lot of money on fillers and

it would not have gotten her the result that she wanted. So that's why

having that conversation is so important and understanding

what the patient is seeing, because it's some. It doesn't always

match what we see as a priority. People off, you

know, they know what they want sometimes, but they don't know what they

need. And it isn't like you're ordering

sushi off a menu, right? Yeah. It's your

decision making conversations. And I love the aha moments when they're like,

oh, yeah, I do see that. Or like you said, after they've had their treatment

and you feel like, yes, we went down the right path and

she or he will feel like we went down the right path. There's no greater

feeling than that. Yeah, for sure. We covered a lot of ground

from temples to cheeks to skin. So

I hope that people got a lot of good information out of it and it

should help everybody make some good decisions when they go in to see their

practitioners. And as always with our episodes,

we really encourage you to ask your questions.

Message us at info@thebeauty

equation.com yeah. And if

you had questions about today, about the tired look or you feel like there's an

area you wanted to, you know, get us to dive a bit deeper, send us

a message or put comments below. And next time I

believe we'll be talking about the angry face,

aka, I'm. Gonna say it, resting bitch face.