50 y/o female with prominent under eye bags - what could be causing this and what can be done to minimize it? (photos)

The lower bulge on the right side is not consistent with lower eyelid fat prolapse and is most likely swelling. This is often called malar bags/festoons and most likely is associated with filler injections as hyaluronic acid based fillers are hydrophilic, ie they attract water.
First plan of actions should be to try to dissolve the filler with hyaluronidase enzyme, if there has EVER been any filler placed in eyelids or cheeks. If you have NEVER had any fillers in your face, then you could consider Morpheus microneedling coupled with Accutite RF treatments.

Hello and thank you for your question. A formal evaluation would be needed to determine the best treatment. There are both surgical and non-surgical options to correct this, depending on your specific situation.

For less significant puffiness and sagging UNDER the eyes, or more mild improvement, there are nonsurgical treatment options: we often use Renuvion helium plasma radiofrequency (RF) energy to achieve incredible results and take years off of your appearance. Combining RF energy and cool helium plasma, the signs of aging (wrinkles, pigmentation, skin laxity) are improved in a ‘Nonsurgical Lower Eyelid Lift.' The focused heating tightens and peels the outer skin layer with extreme precision, leaving the surrounding area undamaged, smoothing and tightening the periorbital skin, and improving the overall skin quality around the eyes. It's an aggressive treatment, and the recovery time is longer than with other nonsurgical procedures, but the results can be life-changing.​

Surgery (a lower blepharoplasty with or without canthopexy/canthoplasty or orbicularis muscle suspension) is a great option for more significant improvement- for example if there are more severe lower eyelid bags / bulging present. Sometimes the surgery can also be used to intentionally adjust the shape and/or size of your eyes, or correct any asymmetries!

Dr. Donald Groves is an expert facial plastic surgeon that I work with, who specializes in these types of procedures. It is important that if you are considering surgery that you go to someone who is well trained and very experienced with these delicate operations to get the best results. I suggest getting a consultation with an experienced cosmetic dermatologist and facial sculpting expert, or an aesthetic facial plastic surgeon like Dr. Groves; we are both located right here in Los Angeles.

Best,
Dr. Emer

You would be a candidate for lower lid blepharoplasty with fat transposition or fat grafting. The herniated lower lid fat is very hydrophilic (likes to absorb water) which means the puffiness can fluctuate. Best to see an eyelid expert.