I still have bags after 2nd lower eye lift surgery. Should I pay for third procedure? (Photo)

Lower blepharoplasty is fraught with possible complications such as ectropion which can be very challenging to correct.  I believe your surgeon was being conservative in his/her approach which I agree with considering over resection of fat or skin would be very problematic.  Where I may differ with your doctor is that I would not charge you for a third revision.  I would expect you to pay for any anesthesia or facility costs only.  That is my approach, but it certainly is not the only approach.  Good luck and be safe.John T. Nguyen, MD, FACS, FICSDouble Board Certified Plastic Surgeon

You appear to have a bit of fat remaining from the lateral fat compartment of both lids.  This is traditionally the hardest fat compartment to treat.  I do suspect that you may require a 3rd procedure to remove this, but I caution you not to proceed too quickly after your last surgery.  Most importantly, you want to be sure you are not developing lower lid lag after these 3 procedure.  6 months may be an adequate amount of time to wait. 

It is still too early to jump into a third surgery and its best to proceed with caution anytime a revision procedure is considered in the eyelids, especially the lower eyelids.  You may have some lateral fat pad remaining; however, excess removal will hollow out your eyes and give you an aged appearance as well.  Before proceeding with a third surgery, I would consider filler or fat grafting to enhance and smooth your eyelid-cheek junction area.  

Removing more fat from your lower eyelid will results in deeper hollows and a result that will likely make you look older.  I regularly perform blepharopsty revisions after a surgery when too much fat has been removed and people end up with hollow upper and or lower eyelids that actually add years to the face. This result can make people look very bizarreA word of caution: this is a delicate surgery that requires a fair amount of experience with fat grafting, and meticulous surgical technique. In experienced hands a smooth, youthful and aesthetically ideal brow-upper lid contour can be achieved. Make sure your surgeon can show you numerous photographic examples of brow-upper lid junction fat grafting.