Am I candidate for lower eyelid surgery or fat injection? (photos)

Thank you for your question. Based on your photos, you appear to be a good candidate for a lower lid blepharoplasty. At our practice, we almost always combine this with fat grafting to help restore a more youthful appearing lower lid. I recommend consultation with a board-certified facial plastic surgeon for an in-person examination. Best of luck!

Fillers can work very well for this kind of problem, which is a very common problem in active cosmetic dermatology practices. The "domino effect," a name coined by my European colleagues, refers to the use of fillers to address unwanted anatomical changes that come with time (like sunken, sagging cheeks and tear troughs and hollows under the eyes) by treating an adjacent area that is responsible for the problem, rather than directly treating the problem. In this case, the use of surgery would not only NOT be addressing the root cause of the problem, but can be expensive, is invasive and typically is associated with considerable downtime. Instead, one might consider the issue in the following manner. If the hollowing of the cheeks seen in the frontal view were treating with a volumizing filler, the face shape would become more youthful and this would likely "lift" the cheeks to improve secondarily the mid-cheek and reduce the prominent smile lines. But, most important, since the upper cheek acts as a support for the under eye area, the hollows would be improved and the teat troughs likely significantly diminished. If still necessary, a less robust filler can then be used to further smooth the tear trough. These treatments, even when performed in the same session, typically engender little to no significant downtime, and the aesthetic results elicit an immediate "Wow!" reaction. And this known as "domino effect," since, just like hitting one domino will knock all the rest down along the line, filling/volumizing one appropriate area can achieve a very desirable secondary benefit in an adjacent area. I gave up injecting fat many years ago for a variety of reasons. It is a relatively expensive two-step procedure, one to remove fat from the donor areas with large bore cannulas and then to similarly inject the fat into the under eye recipient sites. For another, much of the injected fat, despite the promise, does not survive once it is separated from its original blood supply. Moreover, any fat that does survive retains the characteristics of the area from which it is taken, so that when belly fat undergoes a midriff bulge, so too, can the belly fat injected under the eyes. And finally, if anything goes wrong there is no dissolving enzyme to easily get rid of the unwanted fat. So you would be wise to consult a board certified cosmetic dermatologist and ask to see his/her personal B&As before agreeing to proceed. Inexperienced and medspa type injectors often continue to simply "chase after lines and wrinkles," with fillers, rather than approach treatment as described above. Hope this helps and best of luck.

It appears that you are very good candidate for lower, transconjunctival blepharoplasty. Placing small amount of fat grafts along eyelid/cheek junction (malar) area, would further improve your result. Good luck.