The anatomic reason that this under-eye puffiness occurs is that the connective tissue - located between the lower eyelid lash line area and the rim of bone below the eye, called the infraorbital rim of bone, which holds the fat around the eye in place - stretches over time. In your case, this may have happened at an early age due to a familial tendency. Because of this anatomical ‘weakened’ connective tissue, the fat in the area bulges out to create a “pseudoherniation” (similar to a hernia anywhere else in the body, except the “pseudo” prefix applies because it just appears to be bulging out, rather than a true herniation).
The use of topical skin care products are an excellent idea for keeping the fine lines and wrinkles in this area at bay – so, I definitely recommend you continue a good skin care routine around the eyelid skin – but these products won’t prevent or treat the puffy, tired look.
The good news is that the puffy, tired eyes problem is very easy to fix with a minor surgical procedure: using a transconjunctival approach (so that there are no visible scars). Some of the bulging under-eye fat can be removed, some of it can be repositioned and the firm fibrous attachment right next to the nose (called the arcus marginalis), that creates the appearance of a deep groove there, can be released.
This option will give you a very natural-looking contour in this area, that will make you look healthier and more rested. Since there are no visible scars, the recovery from this procedure is very quick – only limited by any bruising you may have for a few days. Lower eyelid surgery patients are often some of the most satisfied cosmetic patients because eyes are such a central source of communication and appearance.
Check out this link to get a visual perspective of the type of improvement you would see from your own lower eyelid blepharoplasty...
In reviewing your photographs you have both a tear trough deformity and also bulging of the lower eyelid fat compartments. You would do well to have a judiciously performed lower eyelid blepharoplasty along with some filler or fat injected along the tear trough area.
A great part of your tired appearance is from the lower eyelid "bags" (fat) and hollowness underneath it. Lower eyelid transconjunctival blepharoplasty (where the existing fat is moved into the lower hollow area) is a great long-lasting, natural option. Filler injection into the hollow area can also achieve improvement. See an oculoplastic surgeon for evaluation.
You have some fat prolapse, and right under that some hollowing in the tear trough. Your options are: surgery with fat repositioning where the prolapsed fat is moved down into the tear trough to make it appear smooth. Non-surgical options would be to put a filler the tear trough which would make the prolapsed fat less noticeable.
Any advice is limited as an examination in person would be required. Based on your photo, you have a combination of loss of volume under the eyes and some herniation, or 'pushing out' of under eye fat. Your options range from least invasive to more, with the more invasive options being more permanent. However, nice results can be obtained with the lesser option.
So, to start with, the least invasive would be to perform some kind of filler around the area, to build up the upper cheek/lower eye loss of volume around the fat that has herniated, options for filler vary from different types of HA (hyaluronic acid) fillers to fat transfer.
Your other option would be a lower eyelid blepharoplasty, there are different approaches and an examination would be required to determine which, if any, would be beneficial for you.
Fillers often can produce a nice temporary
cosmetic improvement in some patients, but not all. They certainly do not
achieve what a well performed blepharoplasty will do.
Fillers can help improve the cosmetic
appearance but you will get only a temporary and limited improvement with them.
A better and long standing correction would be achieved with a blepharoplasty
of the lower lids: Conservatively removing any excess loose skin that may be
present, contouring the bulging fat pads, which are generally inherited,
unrelated to weight, and tend to protrude more with time, and smoothing the
tear troughs with micro-fat grafts or fat repositioning.
Keep in mind that following advice from a
surgeon on this or any other website who proposes to tell you what to do based
on two dimensional photos without examining you, physically feeling your
tissue, assessing your desired outcome, taking a full medical history and
discussing the pros and cons of each operative procedure would not be in your
best surgery. I would suggest that you find a surgeon certified by the American
Board of American Plastic Surgery and one who is ideally a member of The
American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are
comfortable with. You should discuss your concerns with that surgeon in person.
Robert Singer, M.D., FACS
anderson6791, I would recommend a "SOOF lift blepharoplasty", please see my web site for further information. I've been using this approach for over 15 years with excellent results. Good luck!!
The puffy and tired look of the lower lids is caused from herniation of the 3 orbital fat compartments. At 35 years of age, a trans-conjunctival approach for conservative fat removal will address rejuvenating the lower lids. For many examples please see the link below
I would agree with the other reviewers. A good in person exam would be the ideal way to get an answer. You could go with fillers or eyelid surgery. You seem to be a candidate to have the fat removed from inside the lid leaving you with no scar on the outside and a quicker recovery time should you go that route. Fillers need to be repeated and it is put in the hollow to hide the puffiness.
An actual in person consultation is needed to determine this. You actually have more of a hollow than a bag. I think if you found a skilled injector you could do quite well with fillers rather than surgery for quite some time. The fluids, sleep, vitamin C, retinol are not going to make a difference. Massaging this will make it worse. I would recommend getting some consultations. I would be careful. Try to avoid having the eyelid cut as the first option. You are not in the ideal part of the world for getting cosmetic surgery services. Less is more.