Deep undereye groove, not really tear trough. What procedures are out there to fix this?​ (Photo)

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

It is very likely that small cheek bones are primary cause of your condition. Combination of cheek augmentation with implants or fat grafts with lower transconjuctival blepharoplasty should be consider. Good luck.

At least from the photo and the description that it appears with smiling, the under-eye bulges are likely to be what has become nicknamed "jelly rolls" due to their resemblance to the shape of that candy.
If this is indeed so, then the use of a couple of microdroplets of Botox placed along the "belly" bulge of the muscle responsible for its appearance will diminish or eliminate its appearance with smiling. Just fyi: Botox is not a filler.
You would be wise to consult with an experienced, board certified cosmetic dermatologist and best of luck.