Which Procedure is Right? (Photo)
Doctor Answers 5
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Your skin is too thin for fat grafting and it looks like you have enough fat just to have some removed, repositioning it is good sometimes, but it looks like that might not be the best thing for you. I still like removing some fat through a trans conjuctival incision and then sometimes taking a pinch of skin or using a TCA peel for the crinkly skin.
Lower eyelid blepharoplasty
When herniated fat pads are present, we perform a conservative fat removal through trans-conjunctival approach on the inside of the eyelids. If excess skin is present at rest( not animation), then we perform a pinch technique of the lower lid skin and close that incision with tissue glue. For many examples, please see link below
Which Procedure is Right?
Again NOTHING replace IN PERSON examination! My guess would be a transconjunctival bleph with a combination fat grafting and either TCA or modified phenol peel.
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From your photos, you would do well with the fat repositioning.
It does not look like you have so much fat that any should be taken out. I would try to place it all into the tear trough. And if this is done, you shouldn't need a fat transfer. Once the fat is repositioned, you may have some extra skin which could be removed with a pinch. Or you could do the TCA peel which will give you some tightening. If you still have extra skin, you can remove that easily in the future.