Age 32, what procedure would correct the puffiness and shadows under my eyes? (Photo)

Thank you for reaching out with your concerns. From your description and the photo, it seems that you are dealing with both pseudoherniated fat pads and malar edema, which can contribute to the puffiness and shadows under your eyes. To address these issues comprehensively, a combination of treatments may be considered.
For the pseudoherniated fat pads, a surgical procedure known as lower blepharoplasty could be effective. This procedure involves repositioning or removing the excess fat causing the puffiness, and adjusting any excess skin. However, addressing malar edema requires a different approach. Laser treatments can indeed help improve edema by promoting lymphatic drainage and reducing inflammation. Antihistamines can be beneficial since the edema is histamine-mediated, not necessarily due to allergies. If you have had filler in the past to this area, dissolving the filler may help (and then undergo fat grafting to restore volume if desired).
Considering your desire to avoid prolonged treatments, a surgical approach might offer more immediate and lasting results for the fat pad issue. However, for the malar edema, a combination of laser treatments, antihistamines, and possibly hyaluronidase injections (such as Hylenex) could be explored to help manage the edema. It's important to consult with a skilled facial plastic surgeon who can tailor a treatment plan to address both concerns effectively while taking your preferences into account.

hi, great question but its hard to tell from the pictures. options include dissolving more of the filler, performing lower eyelid blepharoplasty, placing more filler. If the skin tightening procedure didnt work, its not likely from skin excess, but more from hollows and fat herniation.

If you always look tired or you can't get rid of the puffy bags below your eyes, a lower eyelid lift, also known as a blepharoplasty, may help to refresh your appearance. In the lower lids, recontouring mainly involves finding a solution for the bulging fat causing the lower lids to look puffy and removing excess skin.
The other suggestion would be to go back to the person who did your filler and have them dissolve some of it. I have seen instances where old filler holds on to water and can cause under eye puffiness.

Hello,
Thank you for your question:
The persistent under-eye puffiness and shadowing you’re experiencing, even after dissolving Juvederm, may be due to lingering lymphatic congestion, mild fat pad herniation, or changes in skin texture from the filler. Since Morpheus8 didn’t help, you may benefit from a combination of PRF (platelet-rich fibrin) injections to improve tissue quality, and possibly deep cheek filler to restore midface volume and reduce shadowing indirectly. If these non-surgical options don’t provide relief, a lower blepharoplasty could be considered for a more permanent correction.

Do a quick research of the risks of vision loss after fillers in that area, you'll understand few concepts.

I'd say you have a malar crescent issue, unclear if that was aggravated by the fillers or not, but anyhow it is not a candidate for surgery, there is absolutely no surgical procedure effective against that localized crescent of liquid build up.

Explore massaging, check your thyroid and kidney functions, give up smoking if that's the case, set your menstrual cycle in order if needed, control your blood pressure too.

You're concerned about the hollowing under your eyes
In most cases, this type of hollowing is caused by a combination of tear trough deformity (a depression due to adhesion between the skin and underlying tissue) and protruding fat above it, which creates a visible contour difference and a shadowy effect. This can make you look tired or older than you are.
Since you mentioned that you've dissolved all previous filler, a good option to consider might be under-eye fat repositioning. This procedure helps release the tear trough adhesion and redistributes the fat to create a smoother transition.
Depending on your skin condition, if there's also laxity or sagging in the lower eyelid area, we may consider combining it with lower blepharoplasty, where excess skin is also removed for a more lifted and refreshed appearance.

Hello. Thank you for your question. Your situation is unfortunately one that is very common and I frequently see. HA fillers such as Juvederm, even though they are supposed to be temporary, they never fully go away. There is an inflammatory reaction/fibrosis resulting from chronic lymphatic obstruction to the area that was injected. Just dissolving this often does not do the trick. I usually recommend a combination of lower eyelid bag removal plus nanofat injection to the area and +/- CO2 laser.
Hope this helps!
Paul D. Durand, MDFacial Plastic Surgery ExpertMiami, Florida

Additionally, sometimes the dissolving enzyme is not helpful for undoing the effects of temporary gel fillers. Please consider Consulting with another reputable specialist so you can get a second opinion. I hope this helps. Sincerely, Dr Joseph

Thank you for reaching out and sharing your concerns. Based on your description, it sounds like this is primarily a genetic issue, rather than one caused by fillers or skin laxity. Even at a young age, the three fat pockets in the lower eyelid can protrude through the orbicularis muscle, creating persistent puffiness and shadows under the eyes.
The most effective solution in your case would be a lower blepharoplasty, specifically a transconjunctival approach. This technique allows us to remove or reposition the fat pockets without any external incisions, preserving the natural structure of your eyelids. Since you don’t appear to have excess skin, this would be an ideal option to correct the issue while maintaining a youthful, natural look.

Although most women do not begin to see signs of lower eyelid "puffiness" until their mid-40s, oftentimes it can begin in the late 20s. Several factors come into play. The first are genetics. It is not unusual that either mom or dad went through similar issues early on. The second would be the appearance of darker skin of the lower lid. The photo submitted does not have even lighting and therefore it does not accurately reflect the condition. I would encourage you to explore eyelid surgery that can often be done through a tranconjunctival approach. Good luck.

Hello,
Thanks for your question. Some patients develop lymphatic obstruction after tear trough/lower eye lid filler as the filler gel blocks the normal drainage of swelling around the lower lids. It's good that you had it dissolved. You may still have some long term damage from the injections. Here are some options to attempt to help improve your situation:
1. Radiofrequency eyelid contouring (RF)
2. Fat transposition lower blepharoplasty to reposition fat over the inferior orbital rim to fill in the hollows with your own vascularized fat
3. Transconjunctival lower blepharoplasty to remove excess lower lid fat and midface microfat transfer along with lower eyelid laser resurfacing for skin tightening

Each of these options come with their pros and cons. A consultation with a board-certified plastic surgeon or facial plastic surgeon can help you pick the appropriate procedure for yourself.

Good luck!
Dr. Shah