Aging in the lower lids often does not follow a continuum and can be modulated by inherited lid characteristics. This can also be true of the amount of fatty tissue in the neck. At 43 you are on the early side of surgical rejuvenation of the lower lid though the best assessment will determine the condition of the skin of the lid, and the degree to which the fat in the lid is prominent. I believe that the first signs of aging tend to be a loss of the fat under the skin where lid joins the cheek, the 'tear trough' zone. If your skin is in good shape fillers, especially fat, can be an excellent non-surgical choice to fill and restore the area. Be sure to have only the most skilled provide fill in the lid and around the eye as this is not an area for amatures to treat and note that this is an 'off label' place for fillers so be certain you understand what will be done and who will do it.
The inherited puffy eye is another matter and surgery may be beneficial to control the puffy look to repair, remove, or reposition fat as needed. Still, depending on where you are on the aging curve at age 43, fill of some type may also compliment the result. A board certified plastic surgeon in your area is a place to start.
Best of luck,
peterejohnsonmd
