I have very puffy thick mono lids that are most obvious from the side. Can they become less puffy without a crease? (Photo)

Hello,It's difficult to accurately answer your question without an in-person evaluation or at least a frontal view photograph.The upper eyelid puffiness can be caused by a prolapsed or enlarged lacrimal gland (tear gland) or orbital fat.  It's not necessarily recommended to debulk the upper eyelid fat at a young age because it can lead to premature deflation and an aged look.  Debulking can also cause a partial or multiple crease to form which may not be desirable. 

Hello there,This is mostly due to maybe some moderate thickness of the skin but mostly it is due to the eye (or globe as we say) is shallow in your eye socket and so it protrudes a bit.  The fullness or roundness of the skin you see is actually the eyeball underneath.  You could thin this tissue but I don't recommend it.  Actually, if you had fat transfer around the eyelids and eyes themselves it might restore some of your previous look.I perform Asian eyelid surgery every day, literally, and I don't recommend surgery for you except in the future to remove some skin, not make a crease, and/or fat transfer.Chase Lay MD

hi,
your photos are limited but it does not appear that your eyeball/globe is protruding but that may also contribute to having puffy eyes....this will be better evaluated in person.  as for any fatty tissue, only way to make an incision to remove or thin out.  if a crease is not created, you will have a visible scar ...which I do not recommend.  hope this helps.