It is difficult to tell what needs to be done based on this picture . Puffiness of the lower lids is caused by herniated fat pads in the lower lids. The best method to remove the bags is with a transconjunctival approach lower blepharoplasty. This is done under a brief general anesthesia and expect 10-14 days of swelling and bruising
How Can I Remove Puffiness Under my Eyes? (photo)
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Puffiness under the eyes
The appearance of puffiness under the eyes is probably due to a combination of fat under the eye and a loss of bony support in the area. Some fat removal may improve the appearance of the puffiness, but the surgeon would need to be careful not to remove too much fat because it could make the eye look hollow. When there is not a prominent cheek bone area, the bag looks prominent in comparison. If surgery is performed, make sure the surgeon is aware to only remove the amount of fat that looks puffy.
The aging process has left you an excellent candidate for periorbital rejuvenation either by surgery (blepharoplasty) or by facial filler. Contact your friendly Facial Cosmetic Surgeon for specific details.
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You may be a candidate for an Injectable Filler procedure to fill the grooves in your lower eyelids.
You appear to have deep lower eyelid grooves beneath your puffiness. A well-performed injectable filler procedure may lead to improvement. You should consult a physician experienced in the delicate art of injection lower eyelids with fillers.
Hope this helps you.
Blepharoplasty improves lower eyelid fat
Transconjunctival blepharoplasty or fillers
You have prolapsed lower eyelid fat and a tear trough deformity [hollowness between eyelids and cheek].
There are a couple of different ways to address this:
1. Transconjunctival blepharoplasty [surgery] to excise or reposition your eyelid fat.
2. Injectible fillers [Restylane or Juvederm] to fill in the hollow between the eyelid and cheek.
Both are effective. The surgery is a more permanent solution but is more expensive. The fillers are temporary [last 6-12 months on average] and is less expensive, but need repeat injections every year.
Seek an experienced surgeon/injector.