Lower Eyelid Blepharoplasty and/or A Fat Transfer The Best For Me?

Much depends on your actual surgeon.  You could have benefit by a properly done lower eyelid surgery using an transconjunctival approach with arcus marginalis release.  I personally think fat is not a great option.  It tends to be disappointing over long periods of time.  I think for ease of having the treatment and the ability to adjust a service, Restylane and Perlane fillers are much better options.  However, there is more than one way to go about this.  A great deal will very much depend on who you see, and your on personal feelings about things.  I would recommend avoiding surgery that involves a cut in the lower eyelid skin or lateral canthal procedures.

These are all great questions. The key is to find the most experienced plastic surgeon to examine you and answer them rather then relying on random opinions in this forum. Expert Eyelid surgeons include Board Certified Plastic Surgeons, Facial Plastic Surgeons (ENT), and ophthalmology. There is no such thing as a "eyelid fellowship". The most critical decision to be made in achieving the best plastic surgical result is picking the most experienced and talented, that is the best, plastic surgeon possible. Too often, patients choose a physician based on a catchy ad, the brand name of a technique, the basis of one or two before and after photos, or their web site’s search engine ranking. These criteria will not find the most experienced and talented plastic surgeon. See the below link on how I would research the identity of the best plastic surgeon for your eyelid surgery.#ExperiencedBlepharoplastySurgeon

Dark circles can be caused form many factors.  Too little fat, lax skin, skin vascularity, hyperpigmentation, and anatomical bone structure, and others.  You need to have the problem defined, and start with least invasive to more invasive.  I am only moderately fond of filler under the eyes.  On some occasion, there can be a puffy appearance.  This is not one of the ironclad injection sites.  The body response is not always predictable.  Proceed with caution.

I always tell my patients to have the surgery that makes the most sense to them, but to go with what the recommendations are with the Dr. that you choose.  This is because each Plastic Surgeon will have their preferred technique that works the best for them in their hands in a given situation.  If you were my patient, I would definately prefer fat transfer, because you do not have any laxity of the skin to warrant a blepharoplasty, and your bags are minimal.  Adding a small amount of fat would not only add volume, but would smooth the area.  Good luck!

Your condition is a relatively common one and deserves accurate analysis and discussion. Your esthetics after a procedure will vary greatly by the route you choose with your surgeon. The treatment approach should always be guided by your anatomy. It looks to me that you actually have normal lower lids but significant deficiency of your central cheek bone. This leads to the appearance of baggy under eyes. Without examining your side view photos, it is a little difficult to determine.

Imagine that you want a smoother transition from cheek to lower lids. You can achieve this by removing the mount (fat), filling the valley (cheek and tear trough) or both a little. Fat removal from your under eye region may make your lower lids look even more hollow because they are brought back to the level of the valley (cheek) which is already too sunken.

Too make a long story short, I would probably recommend fat grafting alone to build up the cheeks and tear troughs to a more appropriate level. Restylane is another option but usually not quite as effective. Personally, I do not like implants for the tear trough region.

A lower blepharoplasty (through a transconjunctival approach) with fat transposition will fill in the bags and circles under the eyes quite nicely.  If there are any pigmentary changes of the skin under the eyes, this can be potentially be treated with a chemical or laser peel.

Fillers would also do the job quite nicely; however, in my opinion, they are inferior to fat transposition due to the fact that they are not permanent and need to be re-injected.