Which procedure is best for under eyes, transconjunctival lower bleph or Restylane filler? (Photo)

I would agree with your plastic surgeon. Filler is a nice temporary option for younger patients such as yourself. It is temporary but results can last up to one year or longer. The filler is placed below the "bag" to camouflage the hollows whereas surgery would actually remove the fat causing the lower eyelid bag. It would be reasonably to try undereye filler to see if you're happy with the results. If you don't like the idea of a temporary fix, then a transconjunctivalunctival lower blepharoplasty could be performed. I think that what you demonstrate by lifting up on your lid is probably a more dramatic change than you would see with this procedure. However, a blepharoplasty should create a significant improvement in the lower eyelid bags. I hope this information is helpful.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

In your case, transconjuctival blepharoplasty with fat repositioning is the best long-term treatment option. In the technique, the existing bulge/fat is moved into lower position to fill the hollow area. See an oculoplastic surgeon.

In general, bags under the eyes can be improved with either lower blepharoplasty or fillers.  The surgical option will address the fat causing the bags, and the filler option will camouflage the bags by filling in the hollow area beneath the bags.  Blepharoplasty is a more long term solution than fillers.  

Thank you for providing such good pictures that really show the problem.  Fillers such as Beletero and Restylane might minimize but not complely correct the problem, and while filling the area is a simpler approach I think ultimately you would not be happy, because you would still have some puffiness there from the herniated and malpositioned fat pad.  A transconjunctival blepharoplasty that conserves and repositions your fat pad is the best option.

It is difficult to assess from the photograph but it appears than even though you are quite young you may benefit most for a blepharoplasty where a plastic surgeon removes the fat pads from under the area. Injections of Restylane or Belotero can temporarily hide some problems in the under eye area as well.  Please find a board certified physician and get two opinions before proceeding with surgery that is permanent.