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.

You have some fat that is visible on this side.  After a palsy the muscles relax and there may be a forward shift of the fat.  Botox will not help.  The best solution would be a surgery to remove some of the fat.  This can be done from the inside of the eyelid so there is no scar visible.  

You have a herniating fat pad of your lower eyelid.  This may have been caused by the Bell's palsy but it's something that happens with age as well...but most of the time it's the same on both sides.  Since it's just the affected side, it's probably related to your Bell's palsy.  Nonetheless the treatment is the same...lower blepharoplasty probably just on that one side.  This involves removal of some of the protruding fat of your lower eyelid to make the contour smoother.  

Much would depend on whether there has been complete resolution of the facial palsy.Your photo suggests a tear trough deformity on the left and maybe some fat bulging above.For that a blepharoplasty and either fat transposition or fat grafting could be the answer.An experienced plastic or ophthalmic plastic surgeon should evaluate this sensitive delicate area.Botox might be of assistance .