I’ve had uneven under-eye bags since childhood. What would be my best option? (photo)

There are many things you can do to treat under eye bags, but a combination approach with nonsurgical treatments would give the most improvement: fillers (Belotero, Juvederm Volbella), lasers (Fraxel/CO2), Renuvion (J-Plasma), microneedling/PRP, Cosmelan peels and stem cells. A surgical option to remove skin and/or fat might be the best solution long-term. I suggest getting a formal evaluation with a cosmetic dermatologist to see what is best for you and your goals. Best, Dr. Emer.

I believe scarless lower blepharoplasty would be the ideal treatment with long-lasting natural results. Important to preserve and redistribute the fat bag.

The best long term approach would be surgical correction via a lower blepharoplasty.  If you are wanting improvement without surgery you can use fillers.  They work well when combined with other treatments such as lasers, microneedling, and PRP to address skin tone and texture.

if surgery is not an option or not desired, the best approach would be a combination of Belotero (hyaluronic acid filler) with Microneedling with PRP. The Belotero cam address the asymmetry and the microneedling will induce tightening by induction of collagen production.

I suspect surgery will give you the more dramatic and long term results however if you are not willing to consider surgery, treatment with a hyaluronic acid based filler like Restylane would give you noticeable improvement as well.