I am 52 years old 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?

If the dark bags are due to fatty tissue, then a blepharoplasty would be a good option. Liposuction of the lower eyelid fat may result in contour irregularities as the skin of the lower eyelid is very thin. During lower blepharoplasty, I like to preserve some of that fatty tissue and re-position it at the junction between the cheek and lower eyelid; this junction is referred to as hollows or tear trough deformity. This technique of re-positioning the fatty tissue provides a more youthful contour between the cheek and lower lid.