Lower Blepharoplasty at 20? (photo)

    Conservative fat removal from an incision hidden on the inside of the eyelid is probably the approach you want to pursue.  Whether you have this done now or later depends upon how much this bothers you.  Find a plastic surgeon with ELITE credentials who performs hundreds of facial and eyelid surgeries each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

The lower lids might change a bit after lower blepharoplasty but I'm not sure it's worth having operation. The photographs are not completely revealing so examination would be necessary for better recommendation.

Congenital lower eyelid bags and their treatment at 20 years of age. For more than 35 years I have treated these with a trans conjunctival blepharoplasty to eliminate the eyelid bags. I don't think fillers would be the solution to this problem because the bags are large and it is not a tear trough problem. Fillers I believe will just create larger bags.

Your pictures do appear to show some fat herniation in your lower eyelids, which causes the bags.  This issue can be hereditary in nature, as it is in your case at age 20.  The non-surgical option for treatment would be using a hyaluronic acid filler under the bags to help camouflage them.  This treatment generally helps but is not long lasting.  The other treatment option would be improving the fat herniation with surgery, which would give much longer lasting results.  

 At age 20, you are little bit young to have lower lid fat pad herniation. Make sure your allergies are under good control, no thyroid issues and then consider a transconjunctival lower blepharoplasty whereby all the incisions are made on the inside the eyelids to remove a small amount of fat that is herniated and creating the puffiness. There is also no harm in waiting a few years  until they become a little worse before undergoing surgery. Fillers will only   be a temporizing measure

Hello,

As mentioned, you have deep "tear troughs".  This is a genetic situation where your bone in the upper cheek up to the lower rim of the eye socket is pushed back.  A temporary correction would be to use a filler like Restylane.  Restylane is a better choice than Juvederm here because it is more stable in size from day to day (less affected by your hydration status).  

A permanent (but removable) approach would be to use a small implant called a "tear-trough implant".  These work especially well in situations like yours since they effectively bring the bone forward to match the fat.  The implant looks and feels like bone.

I would caution you against having the fat removed.  Removal of fat is a one-way road. . . once removed it can't be put back.  As you age, you will need that fat to prevent looking skeletonized or hollowed out.

Twenty years old is a little early to consider surgery.  You may want to consider a soft tissue filler such as Juvederm first.  This will help mask the tear trough and help to build up the upper portion of the malar fat pad.  Although the treatment is temporary it will give you an idea if surgery is a better option.