What would you recommend for this tear trough? Lower blepharoplasty? Or fat transfer? (Photos)

I would recommend an evaluation in person including a full eye exam before making any official recommendations or treatment plan. I believe that an upper eyelid blepharoplasty is the minimum needed to achieve proper upper eyelid aesthetics. With a physical exam, it might be determined that a...

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.

The lateral portion of your upper eyelid incision has fullness. This needs to be corrected by extending the incision and connecting the skin. Best Wishes, Gary Horndeski, M.D.