Lower blepharoplasty: remove the fat or simply redistribute it? (Photo)

Redistributing the under eye fat bags is definitely better than just removing it so to avoid sunken hollow eyes after. And that is best done using transconjuntival approach.

You have some moderate fat, more on the left side in this photo.  There are some surgeons who only remove fat.  This can produce an excellent result, but may also cause some hollowing of the lower lid with more of a dark circle than before. Many surgeons now will try to preserve the fat and move it down into the tear trough to create a smooth contour between the cheek and lower lid. If you have a lot of fat, some may also be excised.  Remember that all surgeries can have complications, so just doing a fat reposition does not guarantee an excellent result. Look at some before and after pictures to make sure you like the surgeon's work.If you don't want surgery, some filler into the tear trough will help to smooth out the area so the fat is not as obvious.  The HA filler in this area can often last 1.5 - 2 years.    

Removing fat, redistributing fat, tissue fillers (to hide the fat), as well as fat grafting are all viable techniqes to address lower eyelid bags.  Sometimes removing excess skin along with a lateral canthopexy may also be needed depending on what your issues are.  Every case is different because every patient is different so there is no standard or "best" approach.  The trend in the past decade has been to be less aggressive fat removal as it can produce a more "hollowed out" look that can be difficult to correct years later.  If you do have a lot of fat, it's reasonable and a good idea to remove some, either as a stand alone procedure or in my experience, combining it with another procedure to smoothen your lower eyelid- cheek junction by doing tissue fillers or fat grafting (so you don't have to remove as much fat or try to do it all with fat removal which can result in that hollowed out look).  Adding fat grafts or tissue fillers to the tear troughs/ lower eyelid grooves and upper cheeks can give you a more complete rejuvenated look as it's often times your midface sagging that accentuates or is the cause of your lower eyelid bags/ dark circles.  Whichever technique a surgeon recommends is the one he/ she is comfortable with or has experience with.  While there are risks for tissue fillers and fat transfers to the lower eyelids, there are also risks for removal of fat.  One has to choose the procedure that offers the best results with the risks the patient (and surgeon) is willing to take.  Look at each surgeon's body of work (lots of patient before and after pics, reviews, patient recommendations), complication rates and philosophy, and choose the one who you feel comfortable with.  I feel it's always best to choose someone who has a lot of experience with all the above so that he will be well versed in all the techniques and really be able to know which option is best for you.  Best wishes.