The primary goal of a lower lid blepharoplasty is to remove fatty deposits which are causing the puffiness look. A trans-conjunctival approach is an incision on the inside of the eyelid that can remove fatty deposits that are making the eyes look puffy and swollen. For many examples, please see the link below
From the appearance of your photos, you do seem to be a candidate for a transconjunctival blepharoplasty, especially to take care of the bulges in the outer corners. Please see an Oculoplastic surgeon.
If you had a transcutaneous (incision under the eyelashes) lower eyelid blepharoplasty 17 years ago, it is common for some of the bulging fat to return. This can be corrected with either a transconjunctival lower eyelid surgery with removal of the outside (lateral) fat pads. From your photo, it does appear that there may be a little fat in the central and medial (near the nose) fat pads as well. I would consider fat re-positioning in your case to try and avoid any further loss of volume and to improve the hollowing. If there is any excess skin, then a transcutaneous approach might be appropriate to address the skin excess. A proper evaluation in the office with an experienced surgeon is best to help determine the most appropriate course of action.
Hi. You have a little residual fat in the "lateral fat pad" of the lower eyelid. It seems more obvious on your right side. This can certainly be removed transconjunctivally. Most plastic surgeons and oculo-plastic surgeons could help you with this.
All the best,
Thank you for your question and photograph. The excess fat in the side or lateral pockets could be removed and used to fill the Hollow areas.
However you need to consult an expert oculoplastic surgeon. Secondary blepharoplasty even when done with a trans-conjunctival approach could result in lower lid retraction
You do have some of the lateral fat pads still. These are often more prominent after a fat excision blepharoplasty. You can usually remove this residual fat with a transconjunctival approach. For the hollowing more medially, some filler or fat injection would help.
It looks like there is still pockets of excess fat in the outer corners of your lower eyelids. The fat could be removed with additional surgery. Areas of hollowing could be improved with Restylane injections to help create a smoother eyelid-cheek junction.