I WOULD TRY FILLERS BEFORE GOING IN AND DOING SURGERY , THE DIFFERENCE BETWEEN FAT TRANSFER AND FILLERS ARE FILLER ARE LESS INVASIVE AND CAN LAST 6-9 MONTHS SOMETIMES UP TO A YEAR DEPENDING ON WHICH ONES. FAT TRANSFERS ARE USUALLY SURGICALLY DONE WITH LIPO AND TRANSFERRED TO ANOTHER AREA OF THE BODY. A FAT TRANSFER CAN ALSO BE DONE THROUGH A LOCAL AFTER SURGERY FOR A REPEAT FAT INJECTION. FAT INJECTIONS OR TRANSFERS ARE USUALLY MORE PERMANENT. THIS IS SOMETHING THAT YOU MAY WANT TO SPEAK TO YOUR DOCTOR ABOUT IN A CONSULTATION AND SEE WHAT YOUR OPTIONS ARE.
Recent studies reveal fat herniation is more likely due to growth of fat rather than weakness of the retaining structures as we previously thought. This means, if you live long enough, the fat will grow back to some degree.
You should consider trans-conjunctival blepharoplasty, because you have little excess skin. Also an incision may result in hypo or hyper pigmentation making it stand out unfavorably. Hiding the incision behind the eyelid would be advantageous.
From the photograph, you look like you would be a good candidate for under eye bag removal. It also looks like you have a loss of volume in the face. When volume is lost in the face, sometimes putting filler around the eye is another option. Or, if a lower blepharoplasty is performed, it seems that the best treatment would be to not just remove the fat, but to move the fat into the hollowed area. This is called fat transposition. If the fat is simply removed, it could result in a hollow appearance post-surgery. But, by using the fat in fat transposition, you may have a better result. Seek out an Oculoplastic Surgeon with experience in both surgery and dermal fillers. Good luck.
The best procedure for you based on your single photo would be a trans-conjunctival lower blepharoplasty. That is a procedure that reduces and/or transposes the fat pads of the lower eyelids through an incision behind the eyelid. With that method, there won't be a scar on the front of the eyelid as the scar will be hidden on the inside of the eyelid. This surgery should last you several years, but one can't predict how long it will last as it depends on your genetics, health and lifestyle. Be sure to see a board-certified oculoplastic, facial plastic or general plastic surgeon for consultation.
The eyes are best treated with a combination approach of fillers, lasers, microneedling/PRP for improvement. Ultherapy/thermage, venus legacy all do well for swelling or puffiness. I would suggest consulting an expert. If surgery is an option they will recommend. Best, Dr. Emer.
Thank you for your question and pictures. Lower eyelid surgery (blepharoplasty) aims to address the bags under the eyes. Excess skin and removal or reshaping of the fat smooth’s the contour between the lower eyelid and the cheeks. Your cosmetic surgeon will assess if the procedure can be performed under local anaesthetic.
Scars fade very quickly to become invisible within a few weeks. Your Cosmetic Surgeon will place the lower eyelid scar just under your lower eyelashes. They will decide if you need absorbable or non-absorbable sutures, which can be removed at your next appointment in 5 to 7 days time.
Swelling and bruising can generally last about 7-14 days after surgery. Your Plastic Surgeon will advise you on the aftercare and will carry out a review in approximately one week.
All the Best
the best treatment for you is transconjunctival lower eyelid blepharoplasty. You have lower eyelid excess fat and the only way to resolve this is through surgery.