Blepharoplast alone not enough? Are there additional treatments that could help? (Photos)

The photos provided show signficiant volume deficit in the upper cheeks. And, since the upper cheeks are a major physical support to the under-eye region, lack of volume in that region typically gives rise to the bags, tear troughs and hollows. Surgical procedures do NOT address the issue of volume depletion and thereby would not have been expected to do much for the problems seen in the photos.
On the other hand, in the hands of an experienced, board certified cosmetic dermatologist filler expert, the use of an HA volumizing filler, properly injected in the upper cheeks would like yield an immediate, significant improvement in the appearance of this region.
Sorry for the lack of success with the surgery, but not surprised, since the primary issue of lack of appropriate cheek Volume is typically not addressed by surgery.. You would be wise to consult with an appropriate filler expert. Hope this helps and best of luck.

You continue to have lower lid herniation of fat which creates the “bags.” In my hands you would be a great candidate for transconjunctival lower lid blepharoplasty with fat repositioning. This will take the remaining eyelid fat and move it to the cheek to create a smooth contour and eliminate the tear trough.

Thank you for sharing your concerns and posting your photos. It appears that there is some residual fat which can still be removed or relocated slightly lower to your cheeks. The addition of fillers to the cheek area would significantly improve the appearance as well. Seek consultation with an experienced oculoplastic surgeon.
Good luck,

There is residual fat in the central and lateral compartments causing residual fullness of the lower lids and exacerbating the tear trough and orbital malar lines. A transconjunctival bleph can correct this.

If you had lower eyelid blepharoplasty, it is not clear why you still appear to have fat pads below your eyes. Additionally, you may have some rounding or scleral show at the outside margin of your lower eyelids, and that is something that might need to be taken into account should you proceed with a further procedure. Thank you for your question. Sincerely, Dr. Joseph

This is very likely combination of residual deformity (orbicularis muscle and oblique ligaments were not sufficiently released) and smaller cheek bones. Cheek augmentation with fat or implants, possibly revision of eyelid surgery should be considered. Good luck.

Hi dear. We don't know before the surgery, but what we see now is that the fat bags under your eyes are still there. If I were your surgeon, I would use your fat to fill the hollow in the midface area with a trans position. This would completely solve the problem under your eyes. You won't need a cheek implant with this surgery. Please contact us for more detailed information and consultation