Is it possible for the fat to come back after transconjunctival-blepharoplasty? (Photo)

Dear LR888Thank you for your question and photo!  There can be several things that change with your eyelids over time- return of puffing fat, loss of cheek and malar volume, eyelid skin thinning, and changes in the eyelid muscle ( it can look like puffy fat)!With Warm RegardsTrevor M Born MD

In general, I tell patients that blepharoplasty sets the clock back, but doesn't stop the aging process.  Sun damage, aging skin changes, and general wear and tear will contribute to the return of lumps and bumps as you age.  If the puffiness bothers you, I would recommend making an appointment to discuss your concerns with a local eyelid specialist.  Good luck!

Radiologic studies do suggest that the anterior orbital fat increases in volume over long periods of time, so certainly this would be consistent with the "fat coming back."  It is also important to understand that the skin in this area thins over time.  Many things can cause "bags."  This means that what bothers you could be orbital fat or it could be caused by something else like exposed bone.  For this reason, a personal consultation is very valuable to determine the basis for your concerns and how best to deal with them.

The fat compartments that surround your eye do not fluctuate with changes in weight, and when removed, do not "grow back".  Given your satisfaction with your transconjunctival blepharoplasty 10 years ago, orbital fat protrusion was likely to have been a prominent feature and was appropriately addressed by the procedure. The photos appear to show a deflation and descent of the cheeks, which can be expected as part of the aging process. A combination of volume addition and a cheek lift is most likely to address these changes you see at this time.

Yes, it can protrude forward again after a prior blepharoplasty.  I generally tell my patients they get 10 or more years of improvement from a lower eyelid "fat" blepharoplasty. This is not to say that your situation is specifically fat as it could be swelling.  The lower eyelid-cheek junction is an area that I call the sponges of the face as this area is prone to swelling and fluid retention.  You could try temporarily prep-h to the area (not in the eye though).  If you sleep more on your right side it can swell more on that side as well.  If this is indeed fat then your appearance could be improved by a repeat lower eyelid transconjunctival blepharoplasty.  Best regards.