Lower blepharoplasty or fat graft - which procedure would better address my lower eyelids? (photo)

Lower lid bleph. Can't tell from photo -- best pic is looking up to see if there are prominent fat pads. If there are, then I would remove them, too.

I recommend a lower blepharoplasty with fat repositioning of the fat pad to obliterate the tear troughs.

Best Wishes,

Gary Horndeski, M.D.

At least from the one photo provided, I don't even see the need for an expensive, aggressive surgical facelift with all its attendant risks for post-surgical infection and scarring and prolonged downtime. The kinds of issues seen in the photo, i.e. the under-eye tear troughs and hollows, the volume deficit in the cheeks that is contributing to the infraorbital issues, as well as to the smile lines, marionette lines, and likely (not well seen in the photo) jowls along the jawline can all be addressed by the appropriate use of robust HA fillers. What's more, in the hands of an experienced, board certified cosmetic dermatologist injector, all the above can be accomplished in about a half-hour treatment session with immediate results and little to no significant downtime. Frankly, this kind of filler treatment is a staple of my every day practice and typically elicits an immediate "Wow!" reaction following the treatment session. Hope this helps and best of luck.

The one photograph is it inadequate in order to make a determination about how best to proceed. The primary goal for lower eyelid surgery is to get rid of the fat bags creating the puffy look in the lower lids. In our practice, we do not recommend fat injections to the lower lids