I am a cosmetic oculofacial plastic surgeon practicing for 20 years, specializing in facial aging particularly in complex procedures about the eyes. The puffiness under your eyes is something called lower eyelid fat prolapse, which is the fat that is around the eyes that has pushed forward. At the same time, there is some genetic or anatomic hollowing adjacent to the puffiness. This area often is referred to as the tear trough area, and the lowest part is called the V-deformity of the orbit. You are more concerned about hollowness, therefore you’re thinking about a filler. The downside about fillers is that most patients are afraid that they will have to be committed to doing fillers forever. They are also concerned that they’d end up in a worse condition by virtue of just doing the fillers alone. The fillers that are typically used are from the hyaluronic acid family (HA fillers) and an example is Restylane. The fat in the area, the level of volume loss, and the viscosity of the material are all factors in how fillers are placed in the area. No two doctors do it the same way, and certainly there are possibilities of issues such as bruising and swelling. There are even patients who come to us who need the material dissolved because the filler was too much compared to the adjacent area. In the long-term, it’s not likely that you are going to lose anything by doing a filler. The filler will be metabolized and your body will get rid of it. Your anatomy will basically remain the same as if you never had the filler. There are also other options such as platelet-rich plasma (PRP). Basically, we draw your blood, spin it down and concentrate the part of the blood that has the platelets that are rich in growth factors and things that help improve skin quality. We combine the hyaluronic acid with platelet-rich plasma to get a more synergistic benefit so that there is an overall improvement of the skin and we have been very successful with that. Finding the right doctor who you feel comfortable and confident with is your next step. Meeting with a doctor who can communicate and examine you will allow you to have a more rational approach to what you can have done, and what the long term plan is. When people come to us, a large percentage of our patients stay with us. It’s because we perform a surgical procedure, but then become their primary beauty doctor. It is important that you have a plan and that you understand that you need to come 2-4 times a year. See how that fits into your budget and your schedule and how you address the issues that concern you. I hope that was helpful, I wish you the best of luck, and thank you for question.