Bleph 4 months ago. Should I be concerned with EXTM sensitivity to light, hollowness under my eyes & changes in vision? (Photo)

I am sorry to learn that you're unhappy with the results of your surgery.  I would recommend meeting with your surgeon to discuss your concerns.  If you feel that you would like another opinion regarding options

Your symptoms could be from dry eyes, which can result from incomplete eye blinking and eye closure. Your lower eyelid look a bit low with scleral show (lower eyelid retraction), which could point to incomplete eye closure. See an oculoplastic specialist for evaluation.

Sometimes after a blepharoplasty the eyes can become dry because the tear distribution isn't as efficient. Generally this is treated with moisturizing agents, artificial tears, thicker lubricant at night and possibly a trial of steroid drops. Hollowness can be treated with injections of hyaluronic acid or fat.  Go back to your surgeon for another exam and voice your concerns.

There could be possibility of lagophthalmos during the night. this will cause you to have corneal changes and that can cause light sensitivity. Please make sure to see an ophthalmology and have them check you for lagophthalmos. 

Best to seek complete eye examination t determine if there is an issue. Might offer filler to tear trough depressions after eye exam clearances/

The loss of volume in the lower eyelid could be due to excess fat removal during the procedure (nowadays we tend to preserve the fat rather than excising it)  or pre-existing. A pre-op photo would be helpful. I suggest you undergo lower eyelid rejuvenation with hyaluronic acid filler to replenish the volume loss and improve the eyelid-cheek junction. In some cases blepharoplasty surgery can affect the positional tone of the eyelid (which protects the eye surface) and cause dryness/bluriness. I suggest you dicsuss your concerns with your surgeon and have your eyes assessed by any eye specialist.

From the two  "after" photos it looks like you have a nice result . However,  without  seeing pre-operative photos it is difficult to assess.Vision sensitivity should not be affected by your cosmetic surgery.    I would suggest you see an eye doctor to evaluate.    Sometimes patients may experience dry eyes if the lower eyelids were done through a transconjunctuval approach As far as the hollows under your eyes-  fat transfer to the tear trough area or Restylane Silk may be helpful 

Thanks for your questions and photos. I am assuming you have presented these issues to your surgeon,  but, if not, you need to be checked again. Often we find there are some subtle temporary visual changes with blepharoplasty, but if your vision had already begun to gradually change before surgery so that you didn't really notice much difference, adding in the eyelid surgery could now make the visual change more of an issue--your surgeon may recommend that you see an ophthalmologist. As to the "tired" look or "shadowing", you may have some "hollowing" from the fat removal that was done--often these days we are adding fat to the orbit so that might be a solution for your concerns. At any rate, i'd recommend you start with your original surgeon--hopefully a Board-certified Plastic Surgeon.  Good luck!