Transconjunctival vs. Transcutaneous Blepharoplasty

Based on your photos and your age, I would recommend a transconjunctival approach-which leaves to external scars.  I would not remove any fat but rather reposition the fat by tightening the orbital septum.  Fat removal in this area has been shown to actually make patients look older and more gaunt. You want to preserve as much fat as possible in order to maintain a youthful appearance.

I recommend consulting with at least one more board certified plastic surgeon in your area before making your decision.

Best wishes,

Dr. Bruno

There are many approaches to treating lower eyelid bags. In young patients like yourself this problem can often be treated entirely via volume enhancement of the cheek/lower eyelid (using fat grafting or facial filler such as restylane for example). Depending on how prominent the lower eyelid fat pads are I may recommend concurrent conservative removal of some of the fat via a transconjuctival approach, but this is less common.

I find that if the cheek volume loss isn't addressed the result will be more of a hollowed out look, which isn't as natural appearing.

Both of these techniques are great depending on individual patient characteristics.  I would recommend getting additional opinions from board certified plastic surgeons in your area.  Typically young patients with isolated "puffiness" of the lower eyelids can be appropriately managed with conservative fat resection via the transconjuctival approach.  If other issues exist, then the transcutaneous approach can be used.