Is it C02 or lower eyelid surgery a better option for under eye area? (Photos)

If eyelid swelling is related to filler, it should be managed accordingly. If it is not filler-related, a proper evaluation is needed to determine the underlying reason.
CO2 laser and lower blepharoplasty treat different problems.
CO2 laser is best for fine lines, crepey skin, and mild tightening. It cannot remove fat bags or significantly tighten loose tissue.
Lower blepharoplasty removes or repositions under-eye fat bags, smooths the lid–cheek junction, and can tighten skin and deeper tissues. It treats structural issues the laser cannot.
In many patients they’re often combined for the best result.

Laser resurfacing is great for fine lines and wrinkles but will not do anything to the volume issues of the lower lid. You would benefit from lower eyelid surgery and volume restoration (fat transposition or fat grafting). CO2 by itself would be underwhelming. Best to see an eyelid expert.

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. Based on what you’re describing — persistent under-eye swelling after filler, followed by hollows, laxity, and a disrupted lid-cheek junction — it’s very understandable that you’re exploring more definitive options. I recommend lower blepharoplasty as an option to consider, because lower eyelid blepharoplasty is often the procedure considered when true fat pad prominence, eyelid laxity, or significant contour irregularities remain after filler has dissolved and the tissue has settled. That said, your idea of starting with a CO2 laser is common: CO2 resurfacing can tighten skin, improve fine lines, and modestly improve the lid-cheek transition if skin laxity is a major component. If the primary issue is protruding fat pads, structural laxity, or tethering, CO2 alone may not fully correct it — which is why you may still be thinking about surgery afterward.