Bags under eyes
I think that you need an evaluation in person. Sometimes fat need to be removed if it is significantly bulging, and sometimes filler needs to be used along the lower lid margin to soften the depression created along the lower lid cheek junction.
The primary goal for lower blepharoplasty is to remove herniated fat bags that create the puffiness look. This is performed through a transconjunctival approach on the inside of the eyelid. A conservative amount of fat is removed to prevent a hollow look, but enough is removed to get rid of the puffiness look. If there is excess skin present, then a pinch technique of along the lower lid lash line is performed and that incision closed with tissue glue. For many examples, please see the link below
Noticeable creases/bags under my eyes, what are my options?
Sorry but we just cannot tell from your photo, however lid corrrection might involve fat grafting to fill the lid and cheek and conceal the bags, or might also involve some form of blepharoplasty. You are correct in that we remove much less fat as this too can be aging. Try another consultation to compare.
Seriously, it would help to have a better photograph.
I can't tell what your issues are from this photograph. There are many options including chemical peels for the lower eyelid. The most important thing is to not get into trouble. I am a bit concerned with the description of the procedure. Removal of fat under a lower eyelid crease is seldom a good idea. Generally it is better to resuspend the malar soft-tissues and filler the void that is letting the crease form. You need to make sure that you are seeing individuals on top of their eyelid game. This can be challenging to find in your town.