Which procedure would be the best option to treat my for tired eyes? 36 y/o (photos)

A blepharoplasty with ptosis correction of the upper lid and a lower lid transconjunctival blepharoplasty to remove herniated fat would be recommended.

I recommend upper and lower blepharoplasty. The upper blepharoplasty will remove excess skin. The lower blepharoplasty I would not take out any fat but do fat transposition to fill out the tear troughs and correct the bulging.

Best Wishes,

Gary Horndeski, M.D.

Thank you for posting your question here!My answer will be based on the limited information and pictures provided , for a more personalized and detailed plan please consult with a plastic surgeon in person.From the provided imaged it looks like you have an element of upper eyelid ptosis which could be corrected with ptosis surgery and a blepharoplasty. Additionally you do have a prominent tear trough with herniated fat that can be corrected with a lower eyelid blepharoplasty. if both were done right they will give you a more refreshed and youthful look.
I hope this helps, Best of luck!

The puffiness in your lower eyelids can be treated with safe fat sculpting, and no lower eyelid skin removal so the natural character of your eyes is preserved. If considering lower surgery, I advise you not have lower eyelid skin removed as it does have a high risk of complications such as lower eyelids being pulled down, looking rounded, or even a skin shortage compromising full eyelid closure. With a specialized technique, fat pockets can be sculpted from behind the lower eyelid skin, so there is incision on the eyelid skin. You can refer to the attached video about it

It’s difficult to tell about your upper lids, but you may have something called ptosis, which is a muscle weakness. With regards to your lower lids, a trans conjunctival lower eyelid surgery can accomplish removal of the offending fat bags through an incision on the inside of the eyelid. No external incision is required. This procedure is performed under a brief general anesthesia as an outpatient procedure.

To rejuvenate tired eyes, consider lower blepharoplasty to address under-eye bags, upper blepharoplasty for drooping lids, and tear trough fillers to reduce hollows. Non-surgical options like laser resurfacing or Botox can smooth wrinkles and improve skin texture. For prominent veins, laser therapy is effective. A combination of treatments tailored to your needs will give the best results.

This is a pretty complex area to asses and treat.
There are generally two variables happening simultaneously.
One is the bulging of the lower eyelid, fat pad, which you can push back into place by contracting your obi muscle like you showed in your picture.The second is a loss of midface volume.
Usually one of these two variables will be primary, and the other will be secondary.
In your case, the bulging lower eyelid, fat pads are most likely primary though most people are going to have both.
To treat the bulging lower eyelid fat pads this is best done with a lower eyelid blepharoplasty.
Midface volume restoration can be done in a number of ways.
This include fillers, fat grafting, using implants or a midface lift.
Each of these options have advantages and disadvantages.
Fillers are probably the most ideal and that they are precise and forgiving if patients don’t like the outcome.
Because the area is complex, and there are a multitude of variables, expect providers to have different opinions.
I highly recommend patients rely exclusively on in person consultations.
To find the right provider scheduled multiple consultations with providers in your area.
Bring a set of standard facial pictures to use as reference during the 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 for whatever treatment they are recommending.
Experienced providers should not have a limited collection of before and after pictures.
To find the right provider generally requires having multiple consultations.
This is a complex area and if the surgery isn’t done right, it can leave people worse than before they started.
The biggest mistake patients make is having only one consultation and then schedule surgery.
Doing this more or less eliminates the ability to choose a better provider.
Best,
Mats Hagström MD