Would a lower eyelid blepharoplasty or fillers be the best option for me? 34 y/o female (photos)

lower blepharoplasty -- you have fat pseudoherniation so that is not something that filler will address

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. Based on your concerns, it is difficult to determine from the photos. Therefore, I recommend an in-person consult to determine if you are a candidate for a lower blepharoplasty. hope this helps and best of luck!

The simplest solution to a problem is often the best. And, in this case, the simplest solution would be the use of a robust HA volumizing filler for the cheeks, which would not only help to contour a more feminine, oval, ogee curve for the cheeks, but since the cheeks serve not only to support the under-eye regions and lift the lower cheeks, filler cheek augmentation would likely secondarily significantly improve the under-eye tear troughs and hollows and also improve the smile lines. The results are typically immediate, engender little to no significant downtime, and typically evoke an immediate "Wow!" reaction.
Surgery, on the other hand, besides being expensive and invasive, carries the risks of infection, scarring and a prolonged post-surgical downtime.
You would be wise to consult with a board certified cosmetic dermatologist filler expert.
Hope this helps and best of luck.

Digital photos rarely tell the whole story, however, I feel that trying to camouflage your lower lid bags with filler could lead to a puffier lower eyelid appearance. Thank you for your question I hope this is helpful. Sincerely, Dr Joseph

For puffiness and sagging under the eyes, we often use Renuvion helium plasma radiofrequency energy to achieve incredible results and take years off of your appearance. Combining RF energy and cool helium plasma, the signs of aging (wrinkles, pigmentation, skin laxity) are improved in a ‘Nonsurgical Eyelid Lift.' The focused heating tightens and peels the upper layers of skin with extreme precision, leaving the surrounding area undamaged, smoothing and tightening the periorbital skin, and improving the overall skin quality around the eyes. It's an aggressive treatment, and the recovery time is longer than with other nonsurgical procedures, but the results can be life-changing.​ See an expert to determine if this is the best solution for you. Best, Dr. Emer

This is a difficult area to both assess and treat.
To make a quality assessment we need quality information.
In one of your pictures you’re smiling, which will distort the natural contour and make a difficult to assess the contour.
Plastic surgeons generally do not make assessments with contraction of the muscles of facial expression.
And the other picture, your eyes are closed.
Take a look at how plastic surgeons take before and after pictures to get an idea of the type of pictures were looking for.
Many people have two different volume issues happening immediately adjacent to each other in this complex area.
In the youthful face, the lower eyelid should be tight and snug, and the area immediately below in the upper midface should be full and plump.
As we age, we sometimes develop the reverse.
it’s important to differentiate which of these is primary and which is secondary.
Selecting for treatments the patient is willing to undergo becomes an important part of the discussion.
Sometimes a lower eyelid blepharoplasty in conjunction with restoration of the midface will give the best outcome.
This kind of work is not easy or straightforward so for now, I suggest you focus more on provider selection, which in the end usually becomes the most important variable.
I suggest scheduling multiple in person consultations with plastic surgeons, facial plastic surgeons or oculoplastic surgeons in your community.
I do not recommend relying on virtual consultations.
Bring pictures of yourself to use as reference during each consultation.
During each consultation ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients who had similar facial characteristics.
You can ask providers to show you examples of patients only had eyelid surgery, those who only had volume restoration and those who had both.
Highly experienced surgeons should have access to hundreds or preferably thousands of before, and after pictures to choose from.
There’s no correct number of consultations needed to find the right provider.
The more consultations you scheduled the more likely you are to find the better provider for your needs.
The biggest mistake I see patients make is having only one consultation and then scheduling surgery.
I suppose not having an in person consultation would also be right up there in terms of mistakes before having surgery.
As I mentioned this area is complex and not easy to treat correctly on a regular basis.
I recommend patients be more selective than they may initially think is necessary. This generally means having more in person consultations than first anticipated.
Best,
Mats Hagstrom MD