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)

Karen, for real long lasting beautiful improvement, surgery (blepharoplasty and ancillary measures) represents the best solution.  Before and after web galleries of local plastic surgeons are the best way to shop, and you can do so from your phone.  

There are a variety of different options that can treat under eye bags depending on the specific patients needs and anatomy. Facial fillers can utilized to fill in eye hollows and are non surgical.  By artistically filling the hollows to the point where it is at the same level as the most prominent portion of the "bag", the "bag" can effectively be made to disappear. Specific lasers and micro needling can also help improve the tone and texture in the area, but are generally less effective. Finally, a lower blepharoplasty, is a surgical approach that can reduce baggy eyelids by removing excess skin and protruding fat thus improving the appearance of the lower eyelids.  I often transfer fat during the blepharoplasty to provide a smooth transition from the lower eyelid into the cheek to eliminate the  dark hollow's or "tear troughs".  I recommend going for a consultation with a board certified plastic surgeon or oculoplastic specialist to determine best corrective treatment plan.

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  Based on
your photograph, you may benefit from a lower eyelid blepharoplasty with a septal reset.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

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.

Hello. Thank you for your question, and pictures. I would recommend scheduling an in-person consultation with a board-certified plastic surgeon to discuss which option or options will make the most sense for you. Examining your skin condition in person from all angles will produce the best recommendation. From your photo, you could be a candidate for a lower eyelid surgery, fat transfer, transposition or removal, as well as a laser treatment to improve the surface skin quality or fillers. With so many treatment options available for your concern area, you have great odds of resolving this area to your liking. I wish you the best.
- Daniel Lensink, MD

Hi, a consultation with an eyelid specialist would give you the most accurate treatment plan. Based on your photograph, there can be methods of improvement either non surgically with filler and botox, or surgically with lower eyelid fat transposition, or fat transfer, possible fat removal, pinch skin excision and laser resurfacing for the fine lines. Hope this helps.

This is a common concern for many patients. The aging process causes the skin to loose, and the fat to disappear from under the eyes creating a hollow tired look. This photo does not show the entire area so it is difficult to give you any strong recommendations. But from what I can see, you would likely benefit from lower eyelid rejuvenation and addition of volume with fat or filler. Best wishes

The primary goal for lower eyelid surgery is to remove the fatty deposits creating the puffy look. The secondary or minor goal is to remove any excess skin that rest, not upon smiling. For many examples of upper and lower blepharoplasty, please see link and the video below

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 would recommend you setting up a consultation with a plastic surgeon to go over your options. There area several skin care products that can be beneficial for the dark circles and puffiness, such as a caffeine and/or eye brightening eye creams. A lower blepharoplasty would help by removing excess skin and repositioning fat pads, but again this is something you would want to address in person with your plastic surgeon! Good luck to you!