What is the safest treatment to address puffy/sunken under eyes?

The under eyes are best rejuvenated with surgery in most patients. Fillers can often be used but are not a permanent solution. All interventions carry risk but blindness from any procedure to address the lower lids is extremely uncommon. Best to see an eyelid expert to discuss the best option for you.

The lower lid blepharoplasty procedure is very safe. As a Board Certified and Plastic and Reconstructive Surgeon I routinely perform complete orbital wall reconstructions. Even during that procedure where I am operating under the eye itself blindness is thankfully exceedingly rare (I have never seen it). Therefore during the blepharoplasty procedure where the dissection is limited to the inferior orbital rim the risk for blindness is very low. However, it is very important that you have your procedure performed by a Board Certified Plastic Surgeon. Thank you for your question.

The best treatment for your undereye area depends on your anatomy. If you have puffiness from herniated fat, then a lower blepharoplasty would be the procedure of choice. If you are hollow or sunken, then adding volume from fat grafting or fillers would be more appropriate. Restoring appropriate volume to the cheek is essential too, if the cheek has lost volume. Often people require a combination of treatments (ie, lower blepharoplasty with fat transfer) for optimal results. The risk of blindness from any of these procedures is not zero, but it is very, very, very low. The best way to minimize this risk is to go to someone who has subspecialized knowledge and experience in treating this area, such as an aesthetic fellowship-trained plastic surgeon.