Bunching, Pickering, wrinkles, and asymmetry four weeks after upper blephroplasty - Will they even put? (photo)

4 weeks is insufficient amount of time to determine if further surgery will be necessary. In some cases, upper eyelid laser resurfacing can provide a degree of tightening and improve the symmetry. If excess skin is noted on one side, a revision with removal of more skin can be performed.  

Thank you for sharing your question and posting your photographs. It is much to early to judge the final results of the scar. You will have a better idea at the 6 month mark. See your surgeon or an experienced Oculoplastic Surgeon if the results are not to your liking. Good luck,

One month is still early from surgery. I have may concerns about the horizontal lines on the eyelid platform skin. That is generally an indication that a little too much skin and orbicularis oculi muscle was left on the eyelid platform below the upper eyelid crease. For lack of a more formal term, we call this crepey upper eyelid platform skin. It makes it challenging to hold makeup on the eyelid platform skin. The eyelid platform skin should be snug much like one snugs a bedsheet. This is structurally done by a procedure called anchor blepharoplasty. I also wonder if you will heal with slight upper eyelid ptosis. I recommend letting the eyelids heal for another couple of months. If these issues persist, it is possible to refine the upper blepharoplasty with a revisional procedure. This should not be done until you have healed at least 6 months. If you are serious about revision, consultation is worthwhile at about 4 months of healing. 

Thank you for your photos. Rest assured it is very common to have noticeable asymmetry four weeks after uppe blepharoplasty. The skin may appear more wrinkled, crepey, or full from the swelling. Blinking, squinting, or smiling may make it look even worse. This will subside as the edema (swelling) in the tissues subside and your skin has the chance to heal and tighten back up. If it is not completely resolved, revision surgery can be performed after 3 months. Hope this helps!Johnson C. Lee, MD
Board-Certified Plastic Surgeon