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

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 

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