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.

Morpheus8 and similar energy devices must be used with extreme caution. These devices, especially when used on the face, will melt the fat and cause damage to tissues and deep structures. A lower blepharoplasty will correct dark circles and under-eye puffiness.

Hello- a lower blepharloplasty could help this. Typically this is caused from herniates orbital fat. The surgery typically removes or repositions the fat pads underneath the eyes.

Persistent puffiness and shadows after filler, even after removal, may stem from incorrect filler placement, the filler itself being hydrophilic, or the development of a related condition like a festooon. Because Morpheus8 didn't help, and the swelling persists, you should consult a specialist who can reassess the area to determine if there's remaining filler, a new issue, or if further treatments like laser treatments, chemical peels, or lower blepharoplasty

Thank you for sharing your story. What you’re describing is quite common, and I completely understand how discouraging it can be to still see puffiness and shadows even after having your filler dissolved. The under-eye area is very delicate, and even small changes can have a big impact on how rested or tired you appear.
Persistent swelling or shadows after filler removal can have a few different causes. Sometimes, a small amount of residual filler or scar tissue remains even after dissolution, which can retain water and create a subtle, ongoing puffiness. In other cases, the issue is more anatomical, such as fat pad herniation (when the natural fat under the eyes starts to push forward) or skin thinning, both of which can make the area look puffy or shadowed.
Since you’ve already tried Morpheus8 without noticeable improvement, it’s possible the concern is more structural than skin-deep. When that’s the case, there are a few effective options to consider. A lower blepharoplasty (eyelid surgery) can reposition or remove bulging fat pads to smooth the area and reduce puffiness. For patients who prefer a less invasive approach, microfat or nanofat grafting can restore soft, natural volume and improve the quality of the skin. Energy-based tightening treatments can still complement the results, but they often aren’t enough on their own if the issue is fat or tissue positioning.
The best next step is a consultation with a board-certified facial plastic or oculoplastic surgeon who specializes in under-eye rejuvenation. A detailed in-person evaluation can determine whether the puffiness is from residual filler, tissue changes, or natural anatomy, and guide you toward a personalized solution.
The encouraging news is that this is a very treatable concern, and with the right approach, you can absolutely regain a smoother, refreshed, and more youthful look around your eyes.
Warm regards,Dr. Sibel Atalay, MDBoard-Certified Facial Plastic Surgeon

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.