One of the most common complaints from patients, even at a young age, is puffiness in the lower lids. This is due to the fat pads in the lower lid, which in some people can become chronically puffy. This is due both to the anatomy of their lower lid, and to genetics. The swollen fat can cast a shadow on the lower lid and make the tear trough area appear dark and hollow.
There are two ways to help with this cosmetically. One is to fill in the tear trough below the fat with an HA filler such as Restylane. This will make the area appear smoother and lighter and the filler should last at least a year. The other option is surgery. I prefer to do a fat repositioning blepharoplasty.
In this surgery the fat is moved down into the tear trough from an incision on the inside of the eyelid. If there is extra skin it can be removed from an incision just below the lashes, or tightened with laser. So there are 2 excellent options available to help with the fat bags in the lower lids.