Lower eyelid blepharoplasty versus fillers.
Actually you are what I call a stage one to early stage two in terms if lower eyelid signs of aging (there are three stages) . That means you possibly are a candidate for a new procedure called lateral access recontouring. This technique avoids an incision either in front of (traditional) or behind(transconjunctival) the lower eyelid and instead involves a tiny incision beside the corner of the eye through which the lower lid is recontoured. This procedure was just published in the Journal of Plastic and Reconstructive Surgery in October. We can also send you a copy if you call our office in Birmingham. Generally fillers in the lower eyelid region are not a good idea. There have been cases of immediate and irreversible blindness from the material causing a blockage of the retinal artery and,although that is rare, the swelling and deformity that can occur from a filler which draws water into the region is not rare. The latter condition can be corrected with hyaluronidase injections but it still takes a while to resolve. So, in essence I would recommend the mini-bleph for full correction.
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For the upper lid you would have to consider a blepharoplasty.
That would help to smooth out the upper eyelid by removing the excess skin. Hard to tell from just a photo how much orbital fat you have. You may do fine by putting some filler into the lid just below the fat to smooth out the contour. If you have enough fat, could also consider a fat repositioning bleph. You can discuss both options with your surgeon.
Tear trough injections or blepharoplasty
You could honestly go either way. I would recommend you consult with a board certified plastic surgeon in your area to discuss your options. I think for your lower eyelids, you may want to consider surgery due to the amount of puffiness you have.
Happymomoftwo, I would recommend a "SOOF lift blepharoplasty". Please see my web site for further information. Fillers are an alternative but would only soften the aging appearance of your lower lid. Surgery in my opinion would give the best long term results. Good luck!
Blepharoplasty the right procedure?
I do not think you need either an upper or lower blepharoplasty (eye lift) at this time. Based on your age, fillers in the tear trough would certainly help, and something to tighten the skin of your eyelids would be great. My favorite combination is fat transfer to the tear troughs and cheeks combined with fractional CO2 laser resurfacing. The results are very natural, there are no scars and the recovery is only 5-7 days.