There are several reasons for eye puffiness. These include maxillary sinus inflammation, allergies to the environment, congenital puffiness you may have noticed as eye puffiness from one of your parents, or fat that tends to become more prominent as we age. If you don't have sinus infections then it is one of the latter causes. Some patients will also have puffiness just from excess fluid in the pockets under the eyes. Your facial plastic surgeon is generally also board certified in otolaryngology and should be able to distinguish between the causes. If you think it may be fat, look in a mirror at your lower eyelid as you move your chin down. Fat will bulge outward giving you your answer. You may also have multiple of the above causes for eye puffiness.