Under Eye Bags Still Prominent After Blepharoplasty

Dear Pufferfish,
Transconjunctival lower eyelid surgery removes fat from the lower eyelid. The goal is to improve the contour of the lower eyelids. It is unclear if the fullness seen in your lower eyelids actually represents true herniated orbital fat or merely the descent of the cheek fat that once met the lower eyelid fat to form a continuous fullness into the lower eyelid crease.
Certainly the residual full in your lower eyelid does represent residual lower eyelid fat. However, I would not fault a surgeon for leaving too much fat. Although it can be frustrating to need a revision surgery to remove more lower eyelid fat, this demonstrates a commendable restraint on the part of the surgeon. Leaving too much fat is easier to correct than taking too much fat.
The challenge of any eyelid surgery is getting everything just right. As fat is removed in the lower eyelid, the relative hollowness caused by the fall of the cheek fat that occurs in all of us can be much more visible. That is why there has been a trend toward conserving the lower eyelid fat. In a procedure called an arcus marginalis release, the lower eyelid fat is actually moved as a living graft from the lower eyelid into the top of the cheek to partially filling this hollowness.
Regarding your situation, I think that where you are now is a very good preview of where you will be in three to 9 months. I think it is reasonable to wait a few more months and let the tissues heal but it is likely that you will feel motivated to have a revisional surgery to make your lower eyelids better. Do make sure that you and your doctor are on the same page regarding what you are look to a achieve with the touch up surgery if that is what you elected to do.
Please remember to share you further experiences with the Realself community.

At 3 months, you are probably looking at about 95% of the final result.
From the photo I get the impression that your problem lies not in the fat herniation ("puffy") of the lower lid region but also in the hollowness of the tear trough. Further improvements can be accomplished in 3 ways:
1. additional fat removal
2. filling of the tear trough (fat transfer, injectable fillers).
3. combination of both.
I would wait for a minimum of 9 months before considering any surgical procedures (fat removal or fat grafting). Injectable fillers could be placed a little earlier.
I encourage you to stay in touch with your surgeon so that he can monitor your progress and advise you accordingly.