Brian K. Machida, MD, FACS

My question is if you had a platysmaplasty at the time. Sometimes, that would cause tightness, but it should've subsided by now. There are ways to release the tightness from that procedure, but at this point, it would not be guaranteed.

I don't understand your comment and it may be a confusion of terms. I don't understand why a lower bleph was done for malars, which is not typical. Perhaps you could post a picture with a pointer indicating your concern

If this was scar tissue, then some remains need to be remodeled and settled before attempting revision again. It's hard to know if this was a granuloma from the suture material, if you had a platysmaplasty, or if it was mature scar tissue. The revision needs to wait for one year, and depending on how it looks, it will be difficult to predict the outcome at that point.

This looks like swelling, depending on when the surgery was done. However, it also looks like something was done regarding the fat, either fat grafting or fat transposition. It's best to give it enough time for the swelling to go down and follow up with your doctor if it persists.

You have platysmal bands. I can't tell if you had a platysmplasty. This is not botched. If you had a plasytsmaplasty, more needs to be done to address the bands. If you hadn't had a platsymaplasty, then one might need to be done.

The risk of blindness is always present but is rare in lower blepharoplasty. If you have no bleeding risk, the surgery can be done with minimal risk of blindness, especially since your doctor is oculoplastic with 25 years of experience.

Part of the problem is your large submandibular glands on each side. These are difficult to deal with, and the treatment sometimes causes more complications. If you're concerned about the scarring and creases, that can be revised.

There is no reason not to do it in your 40's, unless you don't really need it. I prefer do this procedure in the 40's because women often look like their daughters in their 20s after the procedure. If you wait longer so you are saggier, you won't be able to achieve your desired result. Doctors refuse because they do not think they can improve someone, so it also depends on their experience and technique.

Endoscopic mid face lifts are different from the deep plane lift done on the entire face. The doctor is taking liberty in his description because it is technically close to bone and deep to most structures, but is not a deep plane facelift.

Your hyperpigmentation is very unusual for your skin type. In the absence of any previous history of laser causing this problem in the past, which you mentioned to the doctor before the procedure, this is not typical and does not imply a surgical error. When you say you spend a lot of money to correct this, does this mean you did chemical peels to take away the pigment, or did you try a different laser to diminish the spots? At any rate, I'm sorry to say that although it's up to your doctor, a refund is not warranted because the result was likely not due to operator error but your body's healing response. It's unfortunate that you have to deal with this.