What is This Red Area Below my Eye...also...Restylane or Lower Blepharoplasty for my Undereye Puffiness?

You need an evaluation by an oculoplastic specialist or dermatologist who has experience with this area first.  They will ask questions regarding the history of the redness, how it changes, etc.  The cause of this (can be something simple) must be identified first before considering treatment to the fat prominence.  As far as the prominent lids go there is associated depressions under the prominence.  If and when treatment is planned it must address both issues so that lower lid contour is preserved.  Please see a specialist for advice.

 

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I read your concern and reviewed your photo.

It would be helpful to know the duration and history involving your right lower eyelid red lesion. If it's been there for some time, it may represent a cluster of superficial capillaries. In my practice, a benign-appearing lesion like this may be treated with a Hyfrecator using a needle tip. This works by delivering electric energy through your skin to cauterize and collapse the vessels. Procedures are performed with topical, or no anesthetic. You may have a small crust over the area for a week, and several treatments are typically necessary. Most cosmetic dermatologists are familliar with the use of the Hyfrecator, so please consult a certified, reputable dermatologist for evaluation and management.

You appear to have typical lower eyelid grooves that may be improved by a well-performed Injectable Filler treatment. You may want to get your red lesion taken care of before considering an injectable filler procedure. My personal preference is to use Silikon-1000, an off-label filler for permanent results.

Rather than get care from doctors who have not examined you, I recommend that you get appropriate  medical care.  You have seen two specialists and presumably you do not like their recommendations.  I suggest that you see other specialists. I would also counsel you against transconjunctival lower belpharoplasty.  You do have the classic indication for this which is apparent fullness of the lower eyelid from herniated fat.  However, removal of this fat will accentuate your lower eyelid hollow.  Once the swelling settles, you will not be pleased with the result of surgery no matter how breezy the surgery sounds.  

In order to tell you what this is more information is requied that is given in your post. How long has it been there? Was its onset associated with trauma, infection etc.? Does it blanch on finger pressure and if so how rapidly does it refill? Does the surface have a sandpaper like feel? Does it itch?

Based on the answers to these and other questions- a face physical examination it could be anything from benign superficial blood vessels to actinic keratosis to a few other things. You need to have a diagnosis before you get a treatment. That is first year medical school logic. If it is only superficial blood vessels lasers are your best option. If this is benign which it most likely is you should address the puffiness first. If it is not benign it should be addressed first.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Does this blanch on pressure? If it does, then it is vascular in nature which looks like one. Recommend seeking more consultation until you have at least two or more similar opinions. Fillers will help reduce the tear trough deformity (hollowness), but will not use this until definitive diagnosis is made about the nature of the lesion.

 The red spot, on your right lower eyelid appears to be a stellate angioma, which is a collection of capillaries.  You do have lower eyelid fat bags that could be removed with a lower Blepharoplasty (I prefer the transconjunctival technique with incision on inside of the lower eyelid) or lower eyelid surgery in about 30 minutes. 

 IMHO, this should be done first and by itself and once the lower eyelids are healed, at around 2-3 months you could have a pulsed dye Laser treatment to remove the angioma.  Cutting out the area will result in a scar and could result in a lower eyelid malposition if scarring pulls the right eyelid down and for those reasons, cutting it out wouldn't be my first option.