Most commonly the puffiness under the eyes is a result of a forward outpouching (pseudoherniation) of the fat that surrounds your eye. Normally this fat is contained around the eye (where it’s hidden) by a thin structure called the orbital septum. It acts very much like a sheet holding the fat back. As we age, this septum becomes thinner and weakens, allowing the fat to “pooch” forward.
In addition to the bags, with aging and gravitational changes, the volume of your cheeks and midface is being reduced and pulled downward. This downward descent of the midface structures and volume loss leaves a deficiency or hollowing under the eyes, resulting in a “tear trough” (nasojugal groove) deformity.
A lower eyelid surgery called lower blepharoplasty with fat repositioning is available to help combat these issues. Lower blepharoplasty is performed through a hidden incision on the inner surface of your eyelid. Through this incision the fat that is “pooching” is mobilized and moved to an area where it is useful – the tear trough, where there is volume deficiency. This serves to move fat away from an area of excess and fill the area of deficit, smoothing the contour between the lower eyelid and the cheek.
Some bruising and swelling is expected after surgery, but most patients are out and about in 10-14 days. Pain and discomfort is mild after surgery.