The photo you submitted, unfortunately, is not ideal because you’re looking down a bit, but I can tell looking at the left side that there is some puffiness under your eyes. The diagnosis I would probably say you have is something called lower eyelid fat prolapse. That means the fat normally behind the eyes pushes forward and creates the bulge that is responsible for the eyes looking puffy.
Eyes that are looking puffy all the time and fat pockets that push forward have one solution called lower eyelid blepharoplasty. Lower eyelid blepharoplasty has an external and internal approach to address the fat pockets. And through my experience, I can tell that the internal approach is a better option for you and that’s called transconjunctival approach. In this procedure, I routinely reduce and sculpt the fat pockets from the inside of the eyelid so that it doesn’t look like they’re pushing forward anymore. This approach is preferred by younger people and those dark skin because there is no outside incision, meaning there’s no sign that you had eyelid surgery. Even an ophthalmologist will have a hard time knowing that eyelid surgery was performed unless the patient told them.
Once the fat is reduced, the natural contour of the eyelid follows the shape of the eye and the area around it. Sometimes when people have issues in this area, they can also have a relative hollow area in the eyelid to cheek region. In general, I tell my patients that we can wait to address that issue if it bothers them. If there are some problems with pigmentation and wrinkling in our darker skin patients, we routinely use something called platelet-rich plasma that is derived from your own blood like a typical blood draw that we do in the office at the time of the procedure. We then concentrate the platelets and use them to help stimulate collagen. Many patients' eyelid skin improved with platelet-rich plasma, and it a popular procedure with my own staff.
To summarize your concern, I would typically do in my practice a transconjunctival blepharoplasty. That means doing it from the inside of the eyelid under local anesthesia with a little bit of sedation (IV sedation or light sedation) and with a typical recovery time of less than a week before most people go back to work. I hope this was helpful, and thank you for your question.