What Treatment Do You Suggest for Puffiness Under Eye and Top of Cheek?

The goal of surgery should be to move the fat lower to the level of your cheeks (if possible) to blend the eyelid into the cheek area. This approach is blepharoplasty with fat transposition. See an oculoplastic surgeon who is comfortable with this technique. 

It's not unusual for patients to request treatment of fat collections in the periorbital regions. Fat collections in this area can occur for a variety of reasons and the treatment will depend upon their causation.Unfortunately, without pictures or a physical examination, it's impossible to define your anatomic deformity and it's cause. Depending upon the deformity, a variety of treatment options may be available. These may include standard blepharoplasty, blepharoplasty with fat transposition, injectable fillers, midface lifts and lateral cheek lifts.For these reasons, it's important that your lower lid puffiness be evaluated by a board certified plastic surgeon with experience in this area. This surgeon should be able to formulate a treatment plan that addresses your anatomic findings and achieves your aesthetic goals.

The puffiness under the eyes is traditionally taken care of with a lower blepharoplasty through a transconjunctival approach on the inside of the lower lid. If the tops of the cheeks are very flat, consideration for cheek implant augmentation should be done. It is important to have a smooth transition between the lower eyelids and skin of cheek for a youthful appearance.

This area has always been a difficult one to address surgically, which is the reason for the numerous types of cheek and mid-face lifts, some of which are fraught with complications, especially in the hands of inexperienced or naive surgeons. Thankfully, the options for malar pads and the lid-cheek junction continue to expand and include fillers, laser liposuction (acculift with the accusculpt laser) and surgery. Which one might be best for you is best dtermined with a face to face consult and discussion of your goals with an experienced surgeon.

Puffiness under the eye is much easier to correct than malar crescents or festoons, which occur at the top of the cheek.
If you are a smoker this can contribute to the formation of these swellings, and surgery will not help unless you quit smoking.
There are different causes for these to develop - some are muscle descent, and all approaches to their correction are limited by persistent swelling after the surgery.

A photo would be most helpful. What you describe could be due to peri-orbital fat, overdeveloped muscle, or a cheek fat pad called a festoon. All coud be treated with some form of blepharoplasty with different expcetions of cure, but to make a recommendation, you should provide photos. Look at some sites to get an idea of views that are needed, and then submit.
You may use the 3 views of my patient as a guide!
http://drkasden.us/casestudy.cfm?cid=244&id=8
sek

You have to be more specific as to the nature of the "puffiness". Puffiness is not a medica nor anatomical term, but a descriptive one. Fullness is another descriptive term. if transitory in nature, this can be due to heavy salt intake or allergies. If constant or developmental, it can be due to absolute or relative increase of peri-orbital fat around the eyeball or weakness of structure holding in ths fat. Hypertrophis muscle around the eyelid can cause fullness. It can be due to thinning of soft tissues below this fat that produces a hollowness below and relative puffiness above or hypoplasis of the unferlying boney structures. You will need a complete history and examintation to determine what the cause is and what options you have which are too numerous to delineate here, I believe.

Two different treatments:1. Non-surgical: Injection of fillers will camouflage the deformity but the correction will only last for the duration of the filler.2. Surgical: redraping of the eye lid fat over the cheek bone and tightening of the muscle and skin.Extension of the dissection into the upper cheek is a must to insure release of the midface and proper position.

Puffiness in the lower eyelid is usually due to pseudohernias of fat which requires removal via transconjunctival or external blepharoplasty approaches, usually.

Puffiness in the cheek (and occasionally the lower eyelid) can be edema fluid and is referred to as malar pouching, festoons or crescents. This is graded as to severity and whether this is static or fluctuant in nature.

Treatment can include dilute deep steroid injections and massage, radiofrequency treatments (monopolar, bipolar, unipolar) direct excision, and extended transcutaneous lower blepharoplasty with cheek lifting, among other options.

However, this problem can be more difficult to treat than the eyelid, so you are forwarned. Consult an experienced eyelid surgeon.

The puffiness under the eyes on the cheek bone is called a festoon. Standard blepharoplasty to remove eye bags can make the festoon look worse.
I use an incisional blepharoplasty with an external incision and carry the incision out toward the side of the lower eyelid so that I can actually lift the cheek skin to remove the festoon.