I had transconjunctival lower blepharoplasty approx 4 and a half years ago but feel my bags are back. Can anyone help? (Photo)

Your problem has not simply been the bags (=excess orbital fat) but also your relatively sunken cheeks. The cheeks are hollow in the tear trough area and below making the bags appear more prominent. The appropriate treatment has to include tear trough and cheek enhancement - not only additional fat removal. This can be accomplished with injectable fillers or fat injections because fat has been removed already. Otherwise, I would have recommended a blepharoplasty with fat transposition.Best of luck!

Thanks for posting the photos. 
It does appear that the bags have returned, almost to the same degree as pre-operatively. A secondary procedure may now be warranted to produce the optimal result. 
A repeat lower blepharoplasty may allow removal of the recurrent fat pad herniation which is causing the baggy appearance. The same transconjunctival approach may be used again, though I suspect a better outcome may occur with a transcutaneous approach this time around as there likely would be benefit with some skin resection. There is a sharp transition between your lower lid and your cheek- known as a tear trough deformity- which can be addressed as well in conjunction with a fat grafting procedure to the cheeks to produce a nice result. In addition, based on the anatomy as depicted in your photos, you may also need a tightening of the lower lid in the form of a lateral canthopexy or lateral canthoplasty (though an examination is needed to know for sure). 
You may also consider undergoing a simultaneous browlift and/or upper blepharoplasty as there is some significant skin excess which may progress later in life to obstruct part of the visual field. 
Best wishes, 
Rohit Jaiswal, MD 
Plastic Surgeon, Las Vegas, NV 

It looks like additional fat from behind your eyes has moved forward. I would recommend repeating lower blepharoplasty surgery and possibly adding volume to your lower eyelids and upper cheeks with fillers to help optimize the eyelid-cheek junction.

So as we age, our mid face falls away from our eyelids. This leaves us looking a little hollow beneath the eyelids and a bit heavy around our mouth. This in conjunction with eye bags make us look generally tired in the mid face. If you were happy with your original surgery then that is good news as I am sure the results are replicable. For me you would do great with the combination of subciliary blepharoplasty with mid face lift. This addresses all three signs of mid facial ageing, rather than just eye bags. There are a few surgeons in London who offer that treatment as well as as a couple in the northwest where I am. I hope you find someone who can help you. Hope that helps, Adam Goodwin

You should seek an opinion from a surgeon who performs lifting of the mid-face as part of the treatment.  Naresh Joshi should be able to advise you.

I think that you also have hypoplastic cheeks and depressions along your orbital rim.  Fillers may help with that. If you have residual fat herniation, then perhaps a revision might be necessary as well.