Bells Palsy 2.5 years ago, I now have under eye puffiness -- what is the best treatment? (Photos)

Bell's palsy is a sudden onset weakening usually of one side of the face. The reason it happens is not always known and it relates to the facial nerve that emerges in front of the ear and branches many times to fire signals at all the muscles of facial expression. One of these muscles is a big circular muscle around the eye called the orbicularis oculi muscle that you activate when you squeeze your eyes shut tightly. It also acts to support the fat behind it like a corset. If it is weak, a bit like having weak abs, the fat behind will tend to bulge.
Having botox will only further weaken it as botox works by relaxing the muscles that pull and cause wrinkles. It is more likely that you will need most likely removal of some of the fat or tightening of the orbicularis muscle (usually in the same procedure - a lower eyelid blepharoplasty).

hi. The problem that you have is due to a lack of tone in the eye muscle which is common after a bells palsy. It is best treated with removal of fat from inside the eyelid. CheersDamien

There are 2 options: 1) Filler injection under eyes; 2) transconjunctival lower blepharoplasty with fat repositioning. Each has pros and cons. See following website and video. Skype consult available.