The puffy lower lids are usually due to pockets of fatty tissue. Sometimes the puffiness may be due to edema, or swelling which can occur in the lower legs. If it is due to fat, then I can perform surgery using an incision on the inside of the lower lid. This eliminates any scar on the outer skin of the lower lid. Pockets of fat can be removed conservatively or redraped over the orbital rim to improve the contour.