What’s the best option to improve under eye circles/atrophied fat? Second blepharoplasty? Only 54 years. 12 years post. (photos)

A combination of laser skin resurfacing and fat or HA filler injection would help restore the volume and improve skin tone and texture. 

I do in fact think you could benefit from injectable fillers in your lower eyelid region. This treatment to fill the lower eyelid bags can be done with many of the hyaluronic acid fillers. We would probably prefer to use Vollure or Voluma although any of these can be used well in this area. Other options with or without fillers can be laser skin resurfacing or peels for this region. Lower eyelid skin can also be improved with routine medical grade skin care. Finally, a conservative revision lower eyelid blepharoplasty could also be performed. You have many options as above 

Consider getting lower eyelid filler injection to restore volume fat loss under the eyes. It would make the area more youthful.

It looks like there is a lot of loose skin in the under eye area. This is best treated with a skin pinch and canthopexy surgery. You would need an in person examination, as this is really hard to tell from photos.

Hello, and thank you for your question. If the hollows under your eyes have returned, you can address this without a second blepharoplasty. The addition of fat to your concern area through a facial fat transfer procedure can restore volume and youthfulness. Also, a laser resurfacing procedure can help restore a smoothed and youthful texture to your skin since a fat transfer will not by itself improve the quality of the surface skin. Schedule an in-person consultation with a board-certified plastic surgeon in your area for more details on the advantages of this treatment approach. I wish you good health.
- Daniel Lensink, MD

1672, consider a "SOOF lift blepharoplasty". See an experienced plastic surgeon that is familiar with this approach and specializes in "only faces". See the video and good luck!

Fillers can help with the hollows under the eyes, but won't improve texture. Make sure to see a physician with both surgical and non-surgical experience with this area! If you want improvement with texture as well as contour, surgery or laser resurfacing would be a better long term solution. Good luck!