No one treatment is the answer for every lower eyelid concern. In fact I give talks on this subject in which I describe the thought process that I go through when evaluating my own patients.
If the problem is puffiness alone, then the correction involves a transconjunctival (incision free) removal of prolapsed infraorbital fat. If the problem involves puffiness and skin excess or laxity, then the correction may require an incisional blepharoplasty where both fat and skin are removed in a conservative fashion. If the problem is skin excess or sagging alone then, skin removal using a well camouflaged incision below the lashes or a "mini-blepharoplasty" using the pinch technique.
Finally if the problem is simply lines and creases without sagging or excess skin, then resurfacing with either a phenol based chemical peel or a carbon dioxide laser is indicated. We use all of these techniques routinely and sometimes combine techniques when indicated. The lower lids are the most complex area of the face in my opinion and whoever you go to must have all of these "tools" in their "toolbox" or you are in the wrong hands! Conservatism is absolutely mandatory in this area ,however, as complications can and do occur if proper judgement is not exercised.
