Candidate for Botox or lower blepharoplasty for uneven under eye pads? (photos)

Your photos suggest asymmetric pre-tarsal orbicular oculi muscles, not fat pad pseudoherniation. An in-person examination is necessary to accurately determine the cause and thus the correct surgical technique to address the asymmetry.

Thank you for sharing your question and your photos. It appears that your lower eyelid becomes slightly puffy when you smile. The first step to try is placement of a very small amount of Botox. This might do the trick for you. See an experienced oculoplastic surgeon for detailed evaluation and treatment. Good luck.

Hi Botox is not the appropriate method for this problem. Maybe fillers can be applied in terms of tear trough problem, but it may not be appropriate to decide with these photos. Of course, the most appropriate solution may be to improve it with lower blepharoplasty.Best regards.