I am 52 years old from Orange County, and look tired all of the time due to the dark bags under my eyes. It feels like fatty tissue. I would like the fat removed. Can this be accomplished with gentle liposuction or is blepharoplasty necessary?

Liposuction for the bags underneath the eyes is not a good option due to (amonth other things) thinness of skin, risk of contour irregularity, and injury to important anatomic structures. A preferred technique is blepharoplasty. The bags are usually due to fat pads we all have in our lower eyelids. If the fat pads are prominent, I perform blepharoplasty to address those fat pads. Usually, I re-position those fat pads into hollow areas in the junction point between the lower eyelid and cheek; this is called fat transposition or reposition. Sometimes, I remove the fat if there is a significant excess of fat. Dark color to the lower eyelid may be due to shadow effect from those fat pads, allergies, pigmentation within the skin, and/or blood vessels beneath the skin. I mention these factors because dark color to the lower eyelid may persist after surgery if it is not due to the shadow effect from the fat pads.