Kansas City Eyelid Surgery doctors

I agree, the area you have outlined in black appears to be more of a festoon problem rather then the lower eyelid itself.  Although these problems do not happen in isolation from each other, I would first start with treatment of the festoon  (with deeper filler or fat).  If not corrected to your satisfaction, then more aggressive treatments can be offered. 

Don't for get about the rest of your face while chasing after the bags. Your festoons don't look too severe from the photo and you have other aging issues/asymmetries as well which all contribute to the look of your age.  Find someone who will look over your entire face and offer a complete evaluation.  Good luck!

All other things being normal on your exam, I would opt for the transconjunctival blepharoplasty. 

I am usually not so adamant with my answers but from your story and photos it does seem like your under eye bags are more of a hereditary problem rather then aging.  If your cheekbones are flat I would consider fat grafting as well. Personally, I do not like the results from filler in this particular situation.  Further, you will be potentially be getting injections every 6-12 months for years!

Having a frank discussion with a provider you trust who can examine you is critical. How have they obtained their best results in similar situations in the past?  What treatments work with your lifestyle and price range? These are all important questions.

Good luck!

Your problem is very complex, transconjuctival blepharoplasty will remove volume, filler injection will add volume!!! as you can see, this does not make too much sense.

Neither one of these options is the best, you can get partial solutions with either. This is usually a familiar trait, most of the time patients like you also have loose skin in the lower eyelid, this can only be determined with an examination. There are 3 key components on examining your problem, excess fat (bulging bags), tear trough deformity (the groove under the fat bags) which is a volume deficiency and most likely excess skin. There are many ways to approach these problems, you need to see a surgeon with experience on blepharoplasties, there are 3 major specialties in which you can find good and bad surgeons (PLastic surgeons ABPS certified, Facial plastic surgeons, which are ENT doctors and Oculoplastic Surgeons, which are ophthalmologist)  You need to see pictures from the surgeon, the best way to find out if they have experience with patients like you is if they can show you pictures of young patients like you, also is very important for you to check the lateral photographs, with this view you can check if the problem is corrected with their proposed treatment. Good luck in finding a good surgeon