What is the best solution for my puffy eyes? (Photo)

Iam 33 years old female, I have puffy eyes since I was 24, it makes look tired and old, what is the best solution for my situation, and how much it will cost.??

Doctor Answers 4

Lower eyelid surgery is your best option, but I do advise an eyelid specialist to perform it without skin removal

As a cosmetic oculofacial plastic surgeon for over 20 years in Manhattan and Long Island, this is the most common procedure that I perform in my practice. The under eye bags are caused by lower eyelid fat prolapse. This is a herniation of fat that is normally behind the eye that pushes forward and creates these bags. It’s generally a genetic trait that tends to run in families. I’ve operated on 3 generations of the same family and certainly I’ve recognized this very strong hereditary factor. There can also be a variable expression at different times.

As someone who’s in their 30s, we generally feel that you don’t have extra skin. This is a very important distinction because a lot of people will go to a general plastic or non-specialized plastic surgeon whose approach to the eyelid is always to do an incision from the lashes or an external approach called a transcutaneous blepharoplasty. Very often, they’ll remove skin that causes the eyelids to pull down.

My approach for you would be a transconjunctival blepharoplasty where I address the fat pockets without interfering with the skin, muscle and support structure. The lower eyelid is deceptively complex; there’s a balance of the lateral canthal tendon, the structures called the septum and the other parts that are very much important in the lower eyelid position. We have seen patients from all over the world whose eyes get pulled down and rounded from complications of lower eyelid surgery.

In addition, we also address skin quality with modalities such as radiofrequency and lasers such as erbium or fractional CO2 laser. This will also help any concern about wrinkles and the perception that there’s too much skin when there isn’t. It is important to distinguish quality of skin from quantity of skin. We also use platelet-rich plasma (PRP) which is derived from your own blood. PRP is a concentration of the healing growth factors that improve the under eye skin significantly at the time of surgery. Since eyelid skin is only a half a millimeter thick, you can’t really put a filler under there. We address fine lines and wrinkles with a laser and use platelet-rich plasma for rejuvenation of the skin. We also use platelet-rich plasma in the rest of the face and other parts of the body.

We do eyelid surgery under local anesthesia with LITE™ IV sedation. This means that you’re relaxed because we’re giving you a medication through a vein like liquid valium. It helps you not feel anything and be comfortable during this procedure. This procedure takes under an hour to perform.

You should now meet with cosmetic surgeons and learn about their personal style and how they approach the lower eyelid bags. Once you meet with the doctor, look at their experience, their results and get a sense of who they are. Make sure your personalities are in sync and that you really can put trust in the doctor doing your surgery. I hope that was helpful, I wish you the best of luck, and thank you for your question.

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New York Oculoplastic Surgeon
4.3 out of 5 stars 70 reviews

Puffy eyes

Thank you for posting your pictures. The circular demarcartion under your eyes L > R, is caused by a ligament called orbito-malar ligament. I have had patients like you treated surgically by releasing this ligament and transposing some of the infraorbital fat into the tear trough area with resolution of the puffiness under the eyes and smoothing the transition from the lower eyelid to the cheek. Do your research in your area, and get evaluated by a plastic surgeon who has had additional training in surgery of the periorbital area. Hope this was helpful. Good luck!

Jose Rodríguez-Feliz, MD
Miami Plastic Surgeon
5.0 out of 5 stars 20 reviews

Puffy eyes

Your case is very difficult to treat - you really need an in person evaluation. There is excess fat in the lower eyelids with severe hollowing along the orbital rim and in the upper cheeks. Filler injections would probably help, but the optimal treatment would involve conservative fat removal with surgery, followed by filler injections 6-8 week later. I find that Restylane injections after surgery produces better outcomes than fat transposition but other doctors will have different opinions on this.

Mitesh Kapadia, MD, PhD
Boston Oculoplastic Surgeon
5.0 out of 5 stars 165 reviews

Puffy lower eyelids have multiple causes

I have added a link that might be helpful...

Hi fattiya1982. Unfortuanately your photos do not provide enough detail in comparison to an in-person consultation.  If your eyelids swell with allergies, then surgery will not get rid of that puffiness.  Some get fullness from strong squinting muscles, and others get fullness from fat pads that push forward with age.  If the puffiness goes away when you are squinting, the fat pads are likely the culprit and a eyelid lift is indicated.  Be sure to have an in-office consultation with a board certified Plastic Surgeon who can help distinguish between these and let you know what the best course of treatment is. Good luck!

Vaishali B. Doolabh, MD, FACS
Jacksonville Plastic Surgeon
4.9 out of 5 stars 33 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.