Your eyelid anatomy looks great - you will have some creasing with smiling and this gives you an alive and natural look. At the very most, a little filler with caution. Surgery is taking an unnecessary risk. Best wishes!
Based on your photos it appears that you would be a good candidate for a combination of tear trough filling and lower blepharoplasty, such as the example in the link below
Do yourself a favor and have under eye fillers for this issue.
You are only going to mess yourself up with surgery. It is simply too traumatic for your issues. Don't have lower eyelid surgery. Do not do fat grafting for this. Less is more. The biggest challenge for you will be finding an injector who knows what they are doing. I have patients who fly in to seem me from all over the world. If they could find a descent injector in London, they would not be flying in for filler service. That does not mean you have to fly to Los Angeles for service but it does mean who does your service makes a huge difference.
There are numerous and excellent options for addressing lower eyelids, both surgical and nonsurgical. Nonsurgical options, like filler and Botox or Dysport,can give excellent results when performed by the proper hands. This truly is a user dependent area, so choose your injector wisely, as there are certain products that should be used in this area and certain ones that should not, but often are.
Surgical options can be minimally invasive but are best discussed after a hands-on examination and discussion of your individual goals and needs.
To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties.
Eyelids- Fillers or Surgery?
experienced artistic plastic surgeons have a variety of procedures, both
non-surgical and surgical, at their disposal to produce excellent cosmetic
results in the appropriately selected patient: neurotoxins (Botox or Dysport),
temporary fillers like Restylane, long lasting micro-fat grafts,
blepharoplasties, and combinations of procedures. There is no one best
procedure. Each has benefits and drawbacks and depends on desired outcome and
In a patient your age, a temporary hyaluronic filler like Restylane and possibly the
addition of Botox or Dysport would be a reasonable place to start.
Following the advice of anyone who would presume to tell you what to do without
seeing photos and without taking a full medical history, examining you, feeling
and assessing your tissue tone, discussing your desired outcome and fully
informing you about the pros and cons of each option would not be in your best
interest. Find a plastic surgeon that you are comfortable with and one that you
trust and listen to his or her advice. The surgeon should be certified by the
American Board of Plastic Surgery and ideally a member of the American Society
for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with
that surgeon in person.
Robert Singer, MD FACS
La Jolla, California
Dark circles underneath eyes
Dark circles can give the appearance of being tired and can have a number of causes. This includes excessive fat below the eyes, midface drooping which can exacerbate hollowing around the eyes, and pigmentation changes to the skin.With dark circles that are attributed to hollowing, tear trough fillers can help, however it is important to be evaluated by your doctor to decide what intervention is right for you.
Voluma as a midfacial filler
I've had good results using Voluma in the upper midface to raise the apparent junction between the lower eyelid and upper cheek. The product is place on the bone and massaged into position.
Lower eyelid surgery candidate
The goal of lower eyelid surgery is to remove a portion of the herniated fat pads that are creating the puffiness look. In patients that are less than 40 years of age, the incision is placed on the inside of the eyelid, also known as a trans-conjunctival approach. In our practice, we do not recommend filler placement around the eyes. Eyelid surgery will not get rid of dark circles. For more information and many examples of what lower eyelid surgery can accomplish, please see the link and the video below