Eye bags or malar fat pads? (Photo)

Dear Mandy,
You have tear troughs, the presence of which can be due to several things, descent of the malar fat bags, progression of orbital fat pads, combinations of both. The correction (surgically) can range from fat transfer into the troughs to lower blepharoplasty with or without fat translocation or grafting. Seek consultation with an American Board of Plastic Surgery board certified plastic surgeon for an examination and discussion of your options. Good luck!

From the very limited photograph, it appears that you have fat bags in the lower lids creating the puffy look. A trans-conjunctival approach lower blepharoplasty can accomplish improvement with the incision located completely on the inside of the eyelid. No external insertion is required. This is performed under a brief general anesthesia as an outpatient procedure