I am trying to figure out what can be done for my under eyes I look tired with circles and puffiness all the time? (Photo)

Most expert experienced artistic plastic surgeons have a variety of procedures, both non-surgical and surgical, at their disposal to produce excellent cosmetic results in the appropriately selected patient: temporary fillers, micro-fat grafts, blepharoplasties and combinations of procedures.  Each has benefits and drawbacks and depends on desired outcome and individual anatomy.

In a patient with your inherited anatomy, a blepharoplasty will produce the best and longest lasting cosmetic result.

Following the advice of anyone who would presume to tell you exactly what to do without taking a full medical history, examining you, feeling and assessing your tissue tone, discussing your desired outcome and fully informing you about the pros and cons of each option would not be in your best interest. Find a plastic surgeon that you are comfortable with and one that you trust and listen to his or her advice. The surgeon should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS 

La Jolla, California

I suspect that you could do very well with a full face chemical peel including a somewhat more intense peel of the lower eyelid.  This firms the lower eyelid tissues and helps even the area even without surgery.  On examination, it may also be appropriate to discussed lower eyelid surgery options including no skin incision, arcus marginalis release surgery. The photograph is not ideal as you are looking down.  Generally it is helpful to seek several opinions before deciding what makes sense for you personally.