What Causes Puffy Eyes?

my under eyes have realy bad puffy bags. why are my eyes ALWAYS puffy? can i do something about it? I'm 34.

Doctor Answers 8

Cause of Puffy Eyes

The eyelids can appear puffy due to genetic predisposition, aging of the eyelid tissue and medical factors. The usual treatment is blepharoplasty, which is the removal of fat (and sometimes skin) to flatten the puffiness. Laser skin resurfacing is often used to complement surgery to remove wrinkles and to give the skin a more youthful, glowing appearance. Sometimes fillers can be placed beneath the bag in order to fill in the shadow and hide the bag. A consultation with an eyelid surgeon who performs all these procedures would be a good first step. I hope you find this useful.

New York Oculoplastic Surgeon
5.0 out of 5 stars 140 reviews

Causes and remedies for puffy eyes

There is no single cause of puffy eyes. So, the treatment depends on the etiology.

  1. Fluid collection (edema): This can be due to fluid overload, medical conditions causing water retention, inflammation from allergy or after surgery, poor lymphatic drainage, among others. The best treatment is to treat the underlying cause (avoid excess salt, sleep with head elevated, gentle massage, warm compresses, allergy medication).
  2. Bulging fat: This may be an aging change and can be corrected most effectively with blepharoplasty.
  3. Infraorbital hollowing: A relative lack of fat under the lower eyelids can create the illusion of puffy eyes. Fillers and fat repositioning work well in this case.

A consultation with an oculofacial plastic surgeon, facial plastic surgeon, plastic surgeon, or dermatologist can be very helpful.

Brett S. Kotlus, MD, MS
New York Oculoplastic Surgeon
5.0 out of 5 stars 58 reviews

Causes of Puffy Eyes Usually Fat Protrusion

Although fluid retention and allergies can cause temporary swelling of the lower eyelids, the most common cause of constant eyelid puffiness is protrusion or herniation of normal eyelid fat.

This is more common with aging, tends to run in families and is common in both men and women.

See the link below for causes and solutions for puffy eyes and eye bags.

Eye bags, circles, and swelling

There are many causes of eye bags. Some are shadow issues, some are discoloration issues.  Most people have a multifactorial problem meaning they have more than one problem causing this demarcation. Below is a list of common issues and some of my treatment protocols.

1. Prolapsed orbital fat through the orbital septum: treated with lower lid blepharoplasty and fat transpositioning. Can also be helped with fillers or auto fat transfer to the face but the ideal treatment in my hands is surgery for this issue.

2. Eczema: much more common in young people with fair skin. The treatment for this is to hold off on makeup and any manipulation of the lower lid for a few weeks and try some topical anti inflammatory creams. If you have allergies those should be treated also.  A dermatologist is the best person to see for this. We have a multidisciplinary clinic with myself, a plastic surgeon, and my partner, a dermatologist which I think is ideal!

3. Fluid accumulation and/or redundant skin. Could be possible in young patients but would need a good facial analysis and exam to determine. A low salt diet (< 1000mg/day) and a warm compress can help.  I would consider treating with filler/fat transfer, lower lid fractional ablative laser and/or lower lid blepharoplasty.

4. Descent of midface cheek pad. This then causes the nasojugular ligament to become more prominent creating a demarcation and separation of the eye from the cheek subunit. Treated with mid face lift and/or fat transfer.

It is all about the balance of this transition from the orbit to the cheek. There are many ways to treat this and they vary by the underlying cause. I recommend seeing a surgeon who also does a lot of these treatments. This can make a big difference as most people have a combination of the above that lead to the issue.

Hope this helps.

Best of luck,


Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Causes of puffy eyes

Puffiness under the eyes that comes and goes can be the result of water retention. Start by reducing your salt intake—and take a good look at the skin products you’re using around your eyes. Gels have a high water content, which might be contributing to the puffiness. Your best bet might be to use lightweight creams or serums, which absorb quickly. If your puffiness doesn’t go away, don’t hesitate to contact us to book an appointment; there might be another cause of the puffiness that can easily be treated in office.

Dennis Gross, MD
New York Dermatologist
4.4 out of 5 stars 5 reviews

What causes puffy eyes?

 The lower  eyelids are composed of skin, muscle and fat. The puffiness is created by fluid retention in the three fatty compartments of the lower lids. It's important to make sure that there are no allergies, thyroid conditions, and try a low-salt diet. If those are not the issue creating the puffiness, then a trans-conjunctival approach with the placement of the incision on the inside of the lower eyelids is performed to  conservatively remove a portion of the fat which is creating the bulge on the outside of the skin. For many examples, please see the link below to our  eyelid surgery photo gallery.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Puffiness under the eyes

There are many causes of under eye puffiness.  The most common cause that I see in my office is a genetic caused weakness of a connective tissue layer that separates the fat cushion around your eyes from the muscle and skin.  While it is genetic, it tends to worsen with age.  The best way to tell if this is the cause of your puffiness is to look up.  If you notice the bulge worsening and coming forward, that's what it is.  This problem is beautifully treated with a transconjunctival blepharoplasty.  Go to the link provided for a more in depth discussion of the different treatment options.

John Bitner, MD
Salt Lake City Facial Plastic Surgeon
4.9 out of 5 stars 87 reviews

Treating Puffy Eyes

Magazines and books often offer a variety of tips and tricks for puffy eyes. They recommend tea bags, hemorrhoid creams, ice, and the like. Unfortunately, puffy eyes are typically caused from mild edema and fat pads, and the only real solution is either blepharoplasty (a permanent option, where a small invisible incision is made and the fat pad below the eye removed under local anesthesia), or the use of fillers to fill in the surrounding area to minimize the appearance of the bags. This latter option is cheaper, involves less downtime, and is minimally painful, however it is only temporary. Hope this helps! 

Cameron Rokhsar, MD, FAAD
New York Dermatologic Surgeon
4.5 out of 5 stars 35 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.