Lower blepharoplasty or filler injection for under eyes
It is difficult to tell if you have enough fat for transconjunctival lower blepharoplasty with fat repositioning, which would be ideal. If not enough fat present, another option would be filler injection in the hollow area.
Transconjunctival blepharoplasty? NO! No surgery is needed since u do not have excess fat or skin. Filler is a better choice if properly done.
You do not have prolapsed orbital fat so would not benefit from a transconj approach to surgery. When not smiling you appear hollow. Have you tried fillers to the lower lid? These may help to fill in the lower lid so that the lines are less pronounced when you smile. In the future you may also want to consider skin excision and possibly transfer to the lower lids.
Should I Have a Transconjunctival Blepharoplasty for Fat Bags. Don't Like How I Look Smiling
There are many issues going on here that really require an in person consult with a board-certified plastic surgeon. It does not appear from the front non-smiling picture that there are significant fat bags, and the low lateral lid position with some scleral show needs further evaluation to see how much lid support there is. There are hollows or flatness under the lids that could indicate flatness of the cheek which increases the risk of lower lid malposition when lower eyelid surgery is done from the outside, as in a skin or skin/muscle flap.
Current approaches include supporting the lower lids with fat grafting to fill in the hollows, then removing a pinch of lower lid skin with muscle support to the orbital rim, or canthal support in addition if needed.
If there is no true excess of fat, then removing intra-orbital fat with a transconjunctival or transcutaneous approach would just make the eye look older and more hollow.
Smiling bunches up the orbicularis muscle which is natural, but does not represent excess fat.
Too many unknowns for an Internet answer. You should get several opinions from experienced plastic surgeons.
Candidate for transconjunctival blepharoplasty
You appear to have both skin and muscle issues and either no fat or very minimal fat problem. In light of this, a transcutaneous approach would be necessary to tighten skin and muscle. Assymetry of lids when smiling is very common and truly normal. I think you can achieve significant improvement with surgery but beware trying to get to perfect. Regarding canthopexy a physical exam is necessary.
Your problem is not fat prolapse thus you are not a good candidate for a transconjunctival Blepharoplasty. Honestly I am not sure you should consider any type of surgery at your age. It seems to be more of a problem related to skin elasticity and may benefit from appropriately placed neurotoxins with the possibility of a medium depth chemical peel.
A transconjunctival blepharoplasty(without a scar on outside of lids) I do when someone is concerned only about the fat that is bulging and not the excess skin. It may leave excess skin if not done on right candidate.
Am I a good patient for Transconjunctival Blepharoplasty?
As the other consultants have said, without skin tightening you will not have a complete result.
I agree with Dr Ferguson with what I cN see from your photos but clearly a full examination is needed
A transconjunctival approach would not be a good choice for you. You require skin excision in addition to fat repositioning to eliminate the "bags." This is best accomplished through a transcutaneous approach (incision below the lash line). A canthopexy would likely be necessary as well, but that is determined by physical exam and cannot be ascertained through a photo.