What causes under eye puffiness?

Thank you for your question. You’re asking what causes under eye puffiness, such as stress besides aging as to affecting the skin under the eyes as well as what is essentially the cause of under eye puffiness.I can help you understand this based on how I explain this to my patients every day in my practice. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Helping people deal with the aesthetics of the under eye area has been a huge part of my practice my entire career. And it is  The questions you’re asking are very understandable because this is what everyone comes into the office stating about why they look the way they do. It can almost be distilled into a common phrase of they are tired of looking tired.
Frequently, when people have under eye puffiness as well as other signs of under eye aging, it can be often interpreted as looking like they’re lacking sleep or lacking energy, maybe even drinking too much. There are a lot of unconscious perceptions, and interestingly, an interesting psychological manifestation of where people look that was actually determined in studies. When people look at you, they look at the eyes, and then go down to the chin in a triangular pattern, so nice looking eyes all the way down to the chin is a very important area. Naturally, when people see someone who doesn't look like they have energy, they naturally think they’re tired.
Starting with the question about under eye puffiness, generally when people reach a point where they’re asking about this, it means that the puffiness is constant. When puffiness under the eyes is constant, it is generally caused by something called lower eyelid fat prolapse where the fat normally around your eyes pushes forward and creates this bulge. The main cause of this is essentially genetics. What many of my patients will tell me, even if they’re in their 30s, 40s and older, they’ll say they’ve had bags under their eyes ever since they were young. What happens is that genetically, along with stressors, aging, environmental changes, this area of puffiness can get worse.
We have many different options for treatment these days, and it can be quite overwhelming for patients seeking optimal solutions. In our practice, we provide everything from skincare products, lasers, injectables, to advanced surgery. For any patient who walks in, we are able to customize a treatment plan for their eyes that’s just right for them.
When you ask about stress, it is understandable because it is an area in the body that seems to be impacted by stressors. Emotional and physical stress can accelerate aging. I always say look at any American president on the first day,  then look at them 4 years later, and you can see in their eyes the stress of this job. When you look at anybody who smokes, somebody who keeps irregular hours, who works nights, you often see it in their eyes.
In helping people with under eye puffiness, we have a straightforward point of decision. If it’s mild puffiness, you can sometimes improve the appearance with an injectable filler to fill an area called the tear trough, and we do that very routinely. For people who are just starting to notice puffiness that’s slight, then placing a filler like a hyaluronic acid filler is a very nice way to soften that transition. When someone has more prominent puffiness which means there’s a lot more fat pushing forward, then fillers are not going to do the job. In those situations, we do a procedure typically called a lower eyelid blepharoplasty. Generally, I use a transconjunctival approach which means I go from the inside of the eyelid so I can avoid an external incision, and retain the natural shape and character of the eyes.
This is a procedure we do in our practice under local anesthesia with LITE™ intravenous sedation, which means our patients walk out pretty much feeling fine and refreshed, and it takes very little time. It’s done in a facility approved by The Joint Commission, the same organization that certifies hospitals.
There are also strategies to help skin wrinkling and discolorations, and this is the other part of the equation to improve the appearance of the eyes. This includes technologies such as the use of platelet-rich plasma derived from your own blood to stimulate collagen and improve discolorations and skin quality. We also use different lasers and radio frequency devices to improve the texture, quality, color, and smoothness of the eyes.
There are a lot of different strategies or tools, and what you need is an optimal strategy to get the best appearance for yourself. It is still very important to maintain a healthy lifestyle as it’s the foundation of the optimal experience in whatever procedure you pursue, so it is important to avoid smoking, take good care of your health, drink lots of water, eat a balanced diet, and manage stress. Basically, anything that’s good for your health is good for your skin.
I recommend you meet with qualified, experienced cosmetic surgeons who are experienced in eyelid surgery, particularly under eye surgery, and provide a wide range of solutions as opposed to those offering single solutions or have limitations. Often, doctors who don't perform surgery will always dissuade patients from doing surgery. It’s unfortunately the reality of medicine, even if you go to a practitioner who isn't a physician, they may just keep trying to point lasers at you, and try all kinds of modalities without treating the underlying cause. I think it’s better to have someone who’s at the top of the chain who is able to do everything rather than try different stabs at doing things that are probably not going to be as helpful. I hope that was helpful, I wish you the best of luck and thank you for your question.

Under eye puffiness is largely related to genetics.  Other factors include but are not limited to allergies, hormonal imbalances, and diet.  The good news is that there are treatments to help improve them.  Simple office treatments such as fillers can help disguise irregularities under the eye.  Surgery, such as the lower blepharoplasty, can also address this area.  Visit with an experienced injector in your area to learn more about options.

Hi, lower eyelid puffiness is usually due to the fat within the eyelid protruding forward as we age. The skin can also become saggy and accentuate the tired look. Also consider lifestyle factors such as salt intake and lack of sleep. Your surgeon can help delineate the proper treatment plan, depending on your anatomic disposition. You may benefit from laser resurfacing and chemical peels to help tighten the skin, however, you may require a lower lid surgery for more definitive improvement.