Too young for lower eyelid surgery?
Age is in an of itself not a reason not to perform surgery. Some patients have a congenital bulge that looks bad. If that bulge is due to a bulge of fat (usually associated with a forward set eyeball), it is a straightforward procedure to reduce it.
If the muscle roll is too wide, that is a more difficult problem. Botox can diminish the roll, but not well. Cheeklifts can use muscle tailoring techniques if they are done through a lateral subciliary incision.
In your case, as the other doctors have noted, probably no surgery is indicated yet.
Getting rid of lower eyelid puffiness can be done with minimal scars
Hi Whaleyb89 - Getting rid of the puffiness underneath your eyes can be done with a standard lower blepharoplasty or transconjunctival blepharoplasty. Both heal amazingly well with minimal scarring, and the transconjunctival one is done via incision inside the eyelids, so you have no scars! It's difficult to determine which procedure is best for you without examining you in person, so make sure you visit several surgeons before proceeding with surgery. Good luck!
No blepharoplasty required (or advised).
I agree with my colleagues here. The "puffiness" is actually muscle and should not be operated on. With caution, a small amount of Botox to the pre-tarsal orbicularis might lessen that appearance. The best approach would probably be a well placed filler such as Juvederm or Restylane to fill in the depression along the rim of the eye socket.
Also, while surgeon's preferences vary, this is *not* an area where fat injections work well, IMO.
All the best,
Lower eyelid surgery and patient age
Lower eyelid surgery is usually not performed on most patients until they are over 40 years of age. On a rare occasion, a patient in their 30s with very severe bags, can have the procedure performed. The primary goal for lower eyelid blepharoplasty is removal of the fat bags, which cause a double bubble effect. There is usually no excess skin or muscle present until the fourth, fifth, or sixth decade of life.
Consider fat transfer first
Your primary problem is a contour issue related to prominent muscle thickening and a trough beneath the eyelid, referred to as a "tear trough". You might try a filler such as Juvederm first to see what correcting this will do for you, but I prefer fat transfer for long term correction of the hollows. Often this will restore a more youthful appearance than fat removal, the exception being some uncommon cases of hereditary premature fat herniation, especially at your age.
Lower eyelid surgery will destroy your appearance
Got to be careful what you look for. Someone will do eyelid surgery, right or wrong. I disagree with the doctors here who want to do something for your orbicularis. Your issue is the hollow under the orbicularis. The treatment for this is not surgical but a little filler in the form of Restylane. The treatment is very comfortable and last well beyond a year. Don't do surgery.
If you do not wish to try a filler + Botox in the tear trough area then only than I might consider a transconjunvital lower lid blepharoplasty. But you really need to see 3 boarded surgeons to helps ypu determine the proper course of action.
There are many options for improving lower eyelids
You are absolutely correct that we generally consider an individual 20 years old to be too young to consider cosmetic lower eyelid surgery. In most cases, there is an alternative explantation for the apparent fullness, puffiness, or other asymmetry.
There does appear to be a loss of smooth contour from your lower eyelash margin over your cheek area. This has resulted in a depression just superior to the bony rim underneath your eye.
In our practice, we would generally recommend one of the hyaluronic acid fillers to be meticulously placed in this depressed area with local anesthesia. This generally gives excellent results, in just a few minutes, and the affect lasted for many months to a year.
Non-surgical blepahroplasty or eyelid surgery
I tend to agree with Dr. Rand's assessment. I do not see any prominent fat pads. I do see a bulge which appears to be muscle and a groove beneath this. The hyperactive muscle could be reduced with Botulinum Toxin whereas the tear through and hollowing could be filled with a hyaluronic product.
Consider fillers and Botox instead of eyelid surgery
Although you may be a candidate for eyelid surgery, as you can see, not many of us would recommend it. I will agree with the majority faction here that you should try some Botox and perhaps a filler if the hollowing bothers you, as well as the puffiness. EVERYTHING we do may have consequences, especially surgery. Good luck!