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.