What are my treatment options for puffiness/fat bags/circles under eyes from thyroid eye disease? (Photo)

Once you condition is stable and under full control, you may consider consultation with a board certified plastic or occuloplastic surgeon (both with experience with few patients with this condition) regarding transconjuctival lower blepharoplasty. This provedure will correct bags and groove underneath. Good luck.

If you live in a major American city, likely in your community there is a University based Oculofacial surgeon who provides the bulk of this care. In the largest cities there are specialist in private practice who also offer these services. There is a new drug approved to control active thyroid eye disease. Only a persona consultation will determine if you are a candidate for this. It can reduce the prominence of your eyes. The treatment is very expensive with significant side effects and it is not for everyone. The first step is to determine if your thyroid eye disease is stable.  Once you are stable, decision have to be made regard on what type of surgical rehabilitation may be needed. The new treatment (teprotumumab) if you are a candidate can reduce the amount of eventual surgery you might need. As a temporary measures, yes filler can be helpful. 

You have in the postinflammatory stage of Graves eye disease before doing eyelid sugery. You will likely benefit from blepharoplasty at that time. It is important to preserve eyelid function so technique is critical. See an expert.

The most important issue with regards to your Grave's disease is that the disease needs to be kept under control prior to any orbital intervention.  Grave's disease typically causes periocular muscle hypertrophy which causes the eyeball to push forward in the globe due to lack of space in the bony cone shaped orbital cavity.   Once it is determined that your active disease has subsided then surgical intervention for proptosis and fat herniation can take place but absolutely not before that.

 As long as your  Thyroid eye disease is stable, a trans-conjunctival lower blepharoplasty  can accomplish removal of the fatty bags  from the inside of the lower lids.  All the incisions are placed on the inside of the lower lids, there is no external incisions.

Dear npoliver,    As an Oculoplastic surgeon, this is a disease I see frequently in my practice.  For patients that have active TED (thyroid eye disease) there is a wonderful new drug recently approved by the FDA that has changed the course of this disease for many who suffer from it. It is called Tepezza and is given by IV every 3 weeks for approx 24 weeks.   It can reverse the signs and symptoms of TED and cause your swelling to recede.  I would certainly seek a consultation from an Oculoplastic surgeon in your area. (You can find one on ASOPRS.org)   If you do not precede with treatment at this time, I would certainly wait until your disease is stable and inactive (15-18 months in a non-smoker, up to 2 years or more in a smoker) to proceed with any surgical options to ensure you have the best result and protect your eyes in the best way possible.  If you are a smoker, quit!  We know that smoking causes the active phase to be more aggressive, less controlled, and more likely to cause long term effects. Good luck