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

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.