There are many options for treating this area. Based on your photos, it looks like you would be a good candidate for transconjunctival lower blepharoplasty with fat repositioning (from the periorbital fat pads themselves). You may need some treatment to the surface of the skin later if there is still some laxity. It does not look like you need any skin excised.
This should be addressed with a transconjunctival approach with preservation of the fat.
The fat should be transposed into the top of the cheek. Doing this it is improbable that you will need fat grafted into the eyelid. You should not have a skin incision because despite the magical thinking of surgeons this will harm the position of the lower eyelid. Study the before and after picture cited below.
From these photos, you would do well with a lower lid transconjunctival fat repositioning surgery. The fat would be moved down into the tear trough to smooth out the area. You should have plenty of fat for this, so would not need to take fat from another area to transfer. Your skin looks pretty good. If you have some excess,it can be removed with a pinch of skin, or tightened with some laser resurfacing.
There's no substitute for a physical examination but you appear to be s perfect candidate for an "inside" lid or Transconjunctival incision with fat bag reduction. Then, should there be residual skin excess it can be removed with a "pinch" blepharoplasty.
Dr. Peter A. Aldea
Incision for Blepharoplasty
You appear to have very little excess skin which would be consistent with your age. You, therefore, need very little skin excision. Therefore, either of the two procedures you described should give you excellent and comparable results in expert hands. Neither has, apparently, suggested fat removal which is good. You do not, however, appear to need added fat from the abdomen, as transposition of the lower lid fat should be adequate.. The transconjunctival method may have a slight edge as far as safety with a slightly decreased chance of drooping of the lateral lower eyelid, but that is about the only other difference.
Transconjunctival vs transcutaneous
I agree with many of the comments below. You do not have that much redundant skin in your lower kids thus a trams conjunctival approach with some fat removal and some redraping over the year trough would be nice for you.
If you don't have a lot of loose skin, a transconjunctival blepharoplasty with fat repositioning may be just the right procedure.Don't shop the procedure or the price, look for the best doctor to do your procedure.
Outside or inside incision for lower eyelid surgery
Most times an inside and outside incision are used. What is more important is what happens through this incision, especially the outside incision. In most cases, it is preferable to remove fat from the inside incision. This avoids disturbing important tissue planes that can scar and pull the lower lid down. An outside incision may be necessary to remove excess skin, but not always. When done correctly, just the excess skin is taken and the muscles that support the lower lid remain. This will rarely if ever cause adverse lower lid scarring. A very careful dissection through the lower lid from the outside to the fat pads can be done, but it has a greater risk and it is almost impossible to know which patient will tolerate this approach.
Hello and thank you for your question. Based on your
photograph, you are a great candidate for a lower eyelid blepharoplasty with a transconjunctival approach to remove some fat with no external incisions. Make sure you
specifically look at before and after pictures of real patients who have
had this surgery performed by your surgeon and evaluate their results. The
most important aspect is to find a surgeon you are comfortable with. I
recommend that you seek consultation with a qualified board-certified plastic
surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon
Outer or inert incision for lower eyelids
Since you are so young, you have very good lower eyelid tone and you have virtually no sun damage. All you have is some puffiness under the eyes caused by some pseudo herniated fat and maybe one or two millimeters of excess skin. This makes you a perfect candidate for a transconjunctival (inside the eye incision) Blepharoplasty and after removal of excess fat you have some excess skin a simple pinch excision of the skin can be performed and you would have an excellent permanent result. I would definitely not perform your lower Blepharoplasty through an external incision.