Would lower eye bag removal only or fat repositioning be better? (Photos)

Do not accept other modalities, only scar-free transconjunctival is acceptable in such a young patient and older ones. Open approach only in very aging ones with bad muscular excess.

I don't recommend in general fat bags repositioning, leads to no actual effect or even bad functional complications, too much risk for no gain.

You have minimal bulging fat , so simply removing fat will either leave you looking hollow or give minimal improvement. . Fat repositioning with release of the arcus marginalis also ( septum between orbital cheek fat ) and adding some fat with fat transfer will give you the best result.

Your photos demonstrate a moderate malar hyperplasia (small cheek bones) which is the leading clause of your eyelid deformity. Correction with cheek implants should be considered first. Lower blepharoplasty, even with lateral canthopexy may create even more problems. A second opinion consultation with an experienced board certified plastic or oculoplastic surgeon is recommended. Good luck.