I've also personally answered your question on a video on YouTube titled, "How to Address Both Sunken Eyes and Puffy Eye Bags with Separate Treatments".My practice has a strong focus on facial aging. In facial aging, there are two things that happen: volume loss and there’s descent or sagging. Volume loss can cause hollowing. In terms of your thyroid hormone levels, you can speak to your medical doctor or internist and have them check hormonal levels. Thyroid hormones are basically a standard testing for any general medical workup. Most patients who come to my practice have volume loss in the eyelid to cheek area or the submalar area. They also have a little bit of fat prolapse where there’s a bag pushing forward. When a person has a bag pushing forward, they think that their face is hollowed because the valley next to the eye bag is deep. They don’t see how the hollowing relates to the puffiness. Lower eyelid puffiness that is constant is called lower eyelid fat prolapse. Paradoxically, you will have volume loss in other areas. You will also lose bone, muscle, fat and soft tissue around the eyes. Genetically, you could have a forward movement of fat that is normally around the orbital space and creates a hernia. We would address this with the most common procedure which we do in our practice called transconjunctival lower eyelid blepharoplasty. In this procedure, we go from the inside of the eyelid and sculpt the eyelid fat so that you don’t have the bulges under your eye. At the same time, we also inform our patients to be mindful of the relative volume loss in the eyelid to cheek junction. We can strategize volume correction based on the patient’s own aesthetic. If they feel that there’s still some volume loss even if they improved the bagginess under the eyes, then we’ll address that using Restylane or another hyaluronic acid filler. We’ll also use platelet-rich plasma which is a product derived from your own blood. This has healing and growth factors from the cells called platelets and the plasma that is separated from the red blood cells. This stimulates collagen formation and blood supply. These are part of the youthful appearance of a vibrant skin that has substance to it. I think that besides seeing your medical doctor, you have to rule out any other metabolic issues. Meet with qualified experienced cosmetic surgeons because surgeons can do both non-surgical and surgical procedures. Also, learn about your options for rejuvenation in the eye area and get a sense of what you’re comfortable with and which doctor you feel would address the type of issue that’s your highest priority. I hope that was helpful, I wish you the best of luck, and thank you for question. This personalized video answer to your question is posted on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.