I have genetically protruding eyes. Do I pursue orbital decompression or upper bleph with a lower orbital implant? (photos)

There are pros and cons for each option you specify. It is best to obtain personal consultation with experienced surgeon. I can tell you orbital decompression is a safe procedure with an experienced surgeon as I have published on this. You can find the manuscript and other details on the following website link. I have even performed orbital decompression plus orbital rim implant for patients who really need it. See following video.

Orbital decompression is a complex problem with more risks that in my opinion is worth it for cosmetic purposes.  As a younger patient, you might consider trying fillers to enhance the lower orbital rim first.  If you like the result, you can look into more permanent options.  Be sure to discuss your goals and concerns with your board certified plastic surgeon and consider the pros and the cons. Be certain your surgeon is properly certified.  I've attached a link where you can start your search. 

You do have a relative lack of inferior orbital rim projection.  This actually could be managed with properly done under eye fillers.  Be careful that you are not prescribing yourself much more surgery than you actually need.  Be careful what you look for.

Hi there.Your previous surgery matters a lot, and to offer opinions on Realself when you've a complex problem, already at least mostly treated, may just mislead you and might not be fair you your current surgeon.For an educated comment to be made, it would be necessary to see your preop pictures. understanding he change to date would be essential.I suggest the best way forward is to post more pictures, including preops. IT may then be possible ot offer helpful advice instead of commenting from the bleachers.I don't disagree that both eye prominence and upper cheek projection are in the conversation. Your best way forward is to continue a healthy discussion with your treating surgeon.All the very best,Howard WebsterPlastic Surgeon

Although orbital decompressions can be safe when performed by an experienced Oculoplastic Surgeon, I don't believe that your issue warrants such an invasive procedure. You have prominent prominent eyes and lower lid bags and this could be markedly improved by under eyelid fillers or possible a canthoplasty and fat grafting. Please seek the opinion of an experienced Oculoplastic Surgeon.

Thank you for an insightful question. I am an Oculoplastic surgeon, with extensive eyelid and orbital experience, so here's my opinion. First of all, you have beautiful eyes that are prominent, so let's concentrate on safely minimizing that which you don't like. An upper blepharoplasty would make them look more prominent, so I would avoid that. Keep the skin fold and the volume that you have, which disguises the prominence of the eyes from above. 
Orbital decompression would put you at risk for loss of vision and permanent double vision, so any reputable surgeon would refuse to do that for you. You should not pursue that. 
Judging from your photos, you could benefit from cheek volume augmentation whether by an implant, fat transfer or filler. The tear troughs could be addressed at the same time with subtle volume. Adding volume in this area would make your eyes look less prominent, without the decompression, by bringing the cheek forward instead of by surgically causing your eyes to sink, which would be safer, and better aesthetically. Hope this helps you. Best of luck!