Lower lid blepharoplasty should ideally preserve most or all of a patient’s lower lid fat, unless there truly is marked excess that is bulging outward. Fat can not only be treated by removal – it can also be restrained, and it can even be repositioned into areas of hollowness such as the tear trough. In addition, fat can be added to areas of hollowness in and around the lower lids to camouflage or ‘correct’ adjacent areas of fullness. I frequently perform structural fat grafting of the lower lid / cheek junction at the time of lower blepharoplasty, to add lower lid support and to blend the contour of the lid and cheek.
Fat grafting of the lower lid area requires experience and meticulous technique. As the area is covered by a very thin layer of skin and muscle, overcorrection must be absolutely avoided. My approach is to graft fat to the point that the area looks aesthetically ideal, then stop and wait 3 months to assess fat survival. As fat survival is variable, additional fat grafting procedures may be performed based on the results of the first. In most cases of post-surgical lower lid hollowness, two to three fat grafting procedures are required to restore adequate subcutaneous fullness in this area.
You appear to be fairly young with no skin excess. You are a good candidate for transconjunctival blepharoplasty. This is a safer procedure than an external approach as you don't disturb the skin and muscle layers. The recovery is therefore easier
Your photos show good skin character, but as you suggest, may be developing volume depletion at the young age of 37. There are several options such as injectable fillers, fat transfer, or surgical blepharoplasty. I would explore the non-surgical options before jumping to a surgical procedure. I agree with Dr. Steinsapir's comments previously expressed in response to your question. Regarding your brows, there is an underlying asymmetry of your eye structures that warrants consideration, more than what I can determine based on just one photo. Best to have an in depth exam and discussion with a qualified surgeon to evaluate how this is bothering you.
At 37 years of age there does not appear to be any skin that needs to be removed from the lower lids since the skin tone is adequate. The herniated 3 fat pads of the lower lids create the puffy look which can be addressed through trans-conjunctival approach lower blepharoplasty. For many examples please see the link below
Based solely on your photos and without an examination it looks to me like any manipulation of the skin or muscle is unneccessary. A transconjunctival approach to sculpt the internal fat pads would probably e all that is necessary.
I can virtually guarantee that a lower eyelid muscle sling surgery will change the shape of your lower eyelid and not in a positive way. Frankly I do not see that your mid face issues warrant this type of surgery which is basically a mid face lift variant. It is hard to precisely know what you need without an actual examination. Thank is because lumps in bumps in the lower eyelid contour can look the same but be caused by different things and need different surgical approaches. I have you tried under eye fillers. If you have not, I would encourage you to start there. For quite some time, you might be very happy with the effects of that approach.
The issue with the upper eyelids is that you are beginning to develop upper eyelid ptosis and you have a compensatory brow lift. Slight asymmetry in this process is pretty normal. Surgery is generally used to correct this issue.