Should I Have Blepharoplasty or Restylane on Tear Trough?

The photograph is not completely telling because you are looking up and a bit to the side, which accentuates the bags under the eyes. Your eye configuration is one of a prominent eyeball (globe); hand in hand with a large eye is often a very visible fat bulge below the eyes.
The most effective way to treat a bulge below the eye is with a transconjunctival blepharoplasty. That way the danger to the lower eyelid is very low.
If you try to build up the areas surrounding the bulges with temporary filler, even if you don't have a complication, you will likely be much poorer (the amounts needed will be significant) and in my opinion I would not recommend that course of action, especially from an aesthetic standpoint.
Aesthetically, you can do the math and see how bulging your lower eyelids would be if everything were brought to the level of the lower eye bulges... not very attractive. Sometimes a small amount of lighter HA filler is excellent at producing camouflage of the bumps without breaking the bank, a good compromise if the patient doesn't want to have surgery and doesn't mind frequent treatments. Typically these treatments would need to be repeated every six months in this area.
It is indeed possible to adjust the lateral canthus to reduce the appearance of a prominent globe with the aid of a limited incision cheeklift. It is also possible to elevate the midface slightly through a cheeklift. But again, lots of surgery. Many articles and chapters on our website drbrent.com under Articles.
Fat transposition surgery usually requires an incision below the eyelid and division of the arcus marginalis. For the small amount of fat you have, I wouldn't recommend that approach. Relatively invasive and complication prone in the wrong hands. I would rather see you have a transconjunctival blepharoplasty and later do small amounts of filler below the eyes.
Restylane and Juvederm are heavy fillers and can in some patients cause edema around the eyelids that is long-lasting (Juvederm more than Restylane), so if you have an important upcoming engagement, do you want to take that chance? There are lighter fillers such as Prevelle which are less risky.
And Radiesse, Artecoll, and any semipermanent filler are in my opinion a terrible idea because of the potential for untreatable lumpiness and chronic inflammatory complications in the future.

It's not unusual for patients with tear trough deformities to request plastic surgical consultation. When this situation arises, a variety of treatment options exist to treat this condition. These include surgical procedures that release the arcus marginalis and the use of injectable hyaluronic acid fillers that minimize tear trough deformities.It's extremely important to individualize the treatment of tear troughs. For this reason, the specific procedure chosen will depend upon the patient's anatomic findings and aesthetic goals.It's important to realize that lower eyelid filler injections can be very effective for treating tear trough deformities, but aren't for everyone with this condition. In some patients the lower eyelid skin is extremely thin and for this reason, injectable fillers aren't always indicated. In addition, this technique only provides a temporary solution to the problem and can sometimes result in lower eyelid discoloration and nodule formation.When patients have excess lower eyelid fat, arcus marginalis release and fat re-positioning is appropriate. This procedure is associated with excellent clinical results.It's important for patients with tear trough deformities to consult a board certified plastic surgeon with experience in this area. This surgeon should be able to formulate a treatment plan that addresses your anatomic findings and achieves your aesthetic goals.

I have good experience with fillers for the under eye area (tear troughs) and have seen beautiful results achieved. I use Teosyal Redensity II, a filler that is specifically for the lower eyelids. It can also help with any dark circles in the area.

From the photograph, you have a little fat in the lower eyelids bulging forward. You also have slight loss of your mid-face(cheeks). A lower blepharoplasty with fat transposition would shift your fat down towards the cheeks. In addition, a little extra volumizing with fillers in the mid-face would accentuate the overall look. See an oculoplastic surgeon who specializes in both procedures. 

If you are concerned about surgery then I would recommend the fillers to address your tear troughs. This would fill them in and you can also add volume to other areas of your face that you'd like to have improved.

Those are great questions. First of all, don't even consider getting injectables in the lower lids and especially not fat injection.  The tear trough that people talk about is sheer nonsense designed to get you to have injections done.  What you need done is a standard lower lid bleoharoplasty to remove the excess fat that causes the puffiness. I am also familiar with this concept  of fat repositioning.  It is also a poorly conceived operation. Stick with what is tried and true.

The approach to the tear troughs is a complex question and is dictated by the patients individual anatomy and characteristics. Common techniques that are approached by themself or in conjunction include:

Correction with filler (fat, HA) (See below weblink for just filler)

Reposition of fat

Removal of fat lower eyelid

All of the above are extremely technique sensitive and both the choice and application of the technique are surgeon dependent.
 

I would try an injection of Restylane or Perlane first. Juvederm is also a good option. The results are very predictable and the downtime is minimal.

A careful filler injection of Restylane can be very effective with a surprising longevity of greater than 1 year. Personally, I do not like Juvederm for the tear troughs...
Lower blepharoplasty with fat repositioning will give you a nice enhancement, too. Recovery is about 12 days. At the end, you may still want a little more volume than you can get from your eyelid fat, though.
The 3rd choice would be fat grafting to the tear trough region. About 1.5 to 2cc of your own material will make a nice difference and this will last years.
But a word of caution: none of these treatments are "easy" except that it is easy for things to look either just different or even worse. Trust yourself to somebody who does a lot of the treatments or procedures you decide upon. Fixing things is usually much more difficult and involved.
Some surgeons may also advocate implants for the tear trough. I just think that they are truly dangerous except in the hands of the (very rare!) expert surgeon.

Dear Eyebaghell

First it is not possible to position your face in a more unflattering manner. Looking up brings out the lower eyelid fat. So this will be your lower eyelid bulges at their absolute worst.

Second, there is no substitue for a personal consultation. Having said that, the biggest problem you have is a relative weakness in the projection of the orbital rim at the top of the cheek. This makes this area lack aesthetic strength and accentuates the tear though area. The arcus marginalis release will take volume from the lower eyelid and place it at the top of the cheek. This will be helpful but the overall effect will be quite modest at best. More radical surgical approaches involve the placement of a tear trough implant or an orbital rim implant like an ePTFE implant. However, these are very big surgeries. Generally I reserve this approach for people who have been disappointed (doctor speak for wrecked) by prior eyelid surgery.

In contrast, filling the lower eyelid with Retylane and the top of the cheek with Perlane will be brilliant. The key is getting enough of these products to make a real difference. It will cost like surgery but I think you need two milliters of Restylane in each lower eyelid (a total of 4 ml) and 0.5 milliliters of Perlane placed at the top of the cheek (a total of 1 ml). The result properly done will be better than any surgery you could have. The service will last about a year and a half.

Don't let anyone talk you into other fillers. Juvederm is a little too "soft" for this area and tends to drift out of the tear trough area and into the top of the cheek. Radiesse can be lumpy in this area as can virtually any other filler including evolence. The other thing about the Restyalne and Perlane is they can be adjusted with Hyaluronidase, an enzyme that erases the filler. This fexiblity is simply not available in nonhyaluronic acid fillers. Because this area has such thin tissue covering, this ability to adjust these treatments make the non surgical make over of this area possible.

Given that you are in the UK, I am going to recommend that you stay away from general plastic surgeons who are going to be primarily interested in cutting you. You really need a cosmetic dermatologist who is doing a lot of under eye Restylane treatment and knows what they are doing. This means doing your homework. I would recommend an eye plastic surgeon but in the UK, these are very rare birds who are too busy to bother with silly treatments.