Would I benefit most from tear trough filler or lower eyelid blepharoplasty? (Photo)

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in person or virtual consultation to develop a custom and effective treatment plan. It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

So sorry you are having this difficulty. Fillers are unlikely to result in gratifying improvement. However, it would be important to know whether you have ever had fillers for this region before. If so, the kind of puffy pillow appearance seen in the photo might then be the result of lymphatic obstruction (lymphedema), which may occur either from an improper choice of HA filler for treating the region and/or too superficially injected filler. Unfortunately, this problem tends to be difficult to treat and does not seem to respond will to hyaluronidase to dissolve the filler. I have personally had success using intralesional anti-inflammatory agents in varying amounts and concentrations along with hyaluronidase, and several treatment sessions are ordinarily required. If fillers have not been used previously, a consultation with a board certified facial or ophthalmic plastic surgeon would be a reasonable course of action. Best of luck.

From your photos it appears you are a good candidate for a lower blepharoplasty which will best address the lower lid concerns that you have. If you are not wanting surgery you can consider fillers to help improve the lower lid contours. I encourage you to begin by visiting a board certified plastic surgeon for a consultation as an in person exam is preferred for a personalized recommendation.

Surgery is the best way to remove the excess fat from under the eyes. However, this is no guarantee that you will be happy with the results. You might get some hollowness that you do not like but that can be filled with fillers. If you are not ready for surgery, fillers can lessen the valleys and improve your overall look.

You have a 'typical' tear trough, though yours is varied from the usual by the position of your orbital ligament. Filler like Juvederm Voluma below the ligament on the muscles to elevate the cheek should correct the problem. Make sure you see an expert in treating this area and do not allow superficial injection with a light filler.