Is tixel safe for the under eye and can in provide an improvement with the apperence of small undereye puffiness? (Photo)

Thank you for your thoughtful question. Tixel is a fractional skin resurfacing treatment that uses thermo-mechanical energy to stimulate collagen production and improve skin texture and laxity. It is considered safe for use in the under-eye area when performed by a trained provider using appropriate settings.

In cases of mild to moderate under-eye puffiness, particularly when related to skin laxity or early fat protrusion, Tixel can offer modest improvement by tightening the skin and improving firmness. However, since you mentioned having genetic lower eyelid fat herniation, it's important to understand that Tixel will not eliminate or significantly reduce true fat prolapse. It may help camouflage the contour irregularity to a degree by improving the surrounding skin’s tone and elasticity, but the results are typically subtle.

For more pronounced or persistent puffiness caused by fat herniation, lower blepharoplasty remains the most definitive solution. That said, Tixel can be a helpful non-surgical adjunct for patients who are not ready for surgery or are looking to enhance skin quality around the eyes.

At least from the photo provided, there appears to be volume deficit in the cheeks, and since the upper mid-cheek region is a major structural support for the under-eyes, when there is volume deficit there, the under-eyes can appear to have bags and wrinkles. I just treated a patient yesterday with exactly the same issue. Properly injected in the right area, a robust HA volumizing filler can both address the volume deficit in the cheek (to create a more ideal, oval, heart-shaped face and Ogee Curve), and secondarily improve the under-eyes. In expert hands, the procedure takes about ten minutes and the results are immediate with little to no significant post-treatment downtime.
When considering expensive "bells and whistles" energy-based devices, exercise a great deal of "buyer beware" caution, since the hard science to back up the use of these often "here-today-gone-tomorrow" devices lags well behind the heavy marketing hype and social media buzz to promote them.
You would be wise to consult with an experienced, board certified cosmetic dermatologist filler injector expert. Hope this helps and saves you time, money and needless frustration and disappointment.