Fat grafting or blepharoplasty? (Photo)

Based on your photo, you are a good candidate for lower eyelid surgery. The excess fat should be removed with blepharoplasty. Then the skin is lasered to tighten it. Finally fat is harvested and injected into the tear trough creases under each eye to make the whole thing nice and smooth. Be sure to see a facial specialist for consultation.

The reason you look older is the fat atrophy of your face and mostly your cheek over the cheek bones. That area also supports your lower eyelids and make a better transition between your lower eyelids and your cheeks. If you look at your own pictures from 10-15 years ago, you'll notice that you have chubbier cheeks. Restoring your facial fat will give your youthful face back, creates better support for your lower eyelids and it is your own fat. To that you could add a bit of skin tightening to your lower eyelids with a lower blepharoplasty incisions under the lash lines.

I would recommend a standard lower lid blepharoplasty removing the excess fat and oreganos a little skin. I am not a fan of fat transfer to the eyelids or what some people call the tear trough. Can cause lumps. It’s a poorly thought out procedure which can cause problems

In our practice, we definitely do not recommend fat grafting due to significant complications we have seen from that procedure. A trans-conjunctival lower blepharoplasty can accomplish removal of the offending fat bags creating the puffy look. The incision is completely located on the inside of the lower lids. No external incision is required