Lower Eyelid Blepharoplasty and/or A Fat Transfer The Best For Me?

I always tell my patients to have the surgery that makes the most sense to them, but to go with what the recommendations are with the Dr. that you choose.  This is because each Plastic Surgeon will have their preferred technique that works the best for them in their hands in a given situation.  If you were my patient, I would definately prefer fat transfer, because you do not have any laxity of the skin to warrant a blepharoplasty, and your bags are minimal.  Adding a small amount of fat would not only add volume, but would smooth the area.  Good luck!

Your condition is a relatively common one and deserves accurate analysis and discussion. Your esthetics after a procedure will vary greatly by the route you choose with your surgeon. The treatment approach should always be guided by your anatomy. It looks to me that you actually have normal lower lids but significant deficiency of your central cheek bone. This leads to the appearance of baggy under eyes. Without examining your side view photos, it is a little difficult to determine.

Imagine that you want a smoother transition from cheek to lower lids. You can achieve this by removing the mount (fat), filling the valley (cheek and tear trough) or both a little. Fat removal from your under eye region may make your lower lids look even more hollow because they are brought back to the level of the valley (cheek) which is already too sunken.

Too make a long story short, I would probably recommend fat grafting alone to build up the cheeks and tear troughs to a more appropriate level. Restylane is another option but usually not quite as effective. Personally, I do not like implants for the tear trough region.

A lower blepharoplasty (through a transconjunctival approach) with fat transposition will fill in the bags and circles under the eyes quite nicely.  If there are any pigmentary changes of the skin under the eyes, this can be potentially be treated with a chemical or laser peel.

Fillers would also do the job quite nicely; however, in my opinion, they are inferior to fat transposition due to the fact that they are not permanent and need to be re-injected.