You have what we call lower eyelid fat prolapse that has nothing to do with body fat but rather it’s the fat that’s anatomically surrounding your eyes. There are two types of fat around the eye: intraconal fat that's directly behind the eye and extraconal fat that surrounds the eye. These fat pockets prolapse and push forward and is called herniated fat. Typically with patients like you, we would do a procedure called a transconjunctival blepharoplasty where we remove excess fat that has pushed forward from the inside of the eyelid. Some of that fat is also repositioned to strategically address the contour of the lower eyelid.When you come into my office, I first understand the support system of your lower eyelid. One of the key elements of lower eyelid surgery, especially when someone gets older, is the loosening or the laxity of tissue around the eye. It’s not just about relative excess skin but there’s a critical anatomical structure called the lateral canthal tendon. The lateral canthal tendon is what anchors the outer corner of the lower eyelid. When you have any surgery under the eyes, there’s a risk that this tendon might be affected and pulls the eyelid down called lower eyelid retraction or lower eyelid ectropion. My evaluation would involve determining whether or not you require any type of support procedure of the lower eyelid such as a lateral tarsal strip or lateral canthoplasty.I would also assess the relative amount of excess skin. When under the eyes has a lot of wrinkles, it’s not because of excess skin but because of skin quality. To enhance skin quality, we would do fractional CO2 laser to tighten skin and stimulate collagen using thermal energy. It also resurfaces some of the skin to restore fresh new skin to the eyelid. If there’s extra skin, we would do a skin pinch excision done by excising a very thin amount of skin underneath the eyelashes. This way, I preserve the integrity of the orbicularis oculi muscle which is very important to support the lower eyelid. Lastly, if the lower eyelid is still loose, I reinforce it by doing lateral tarsal strip. It is important that you understand that there are multiple aspects to rejuvenate or enhance the appearance of the lower eyelids. I suggest that you seek an experienced cosmetic surgeon who performs a lot of eyelid surgery is familiar with the concepts of eyelid support. The surgeon should also be able to do many different techniques to customize a procedure according to what the patient needs.