Could a repeat bleph help eliminate my lower eye wrinkles? (Photo)

You appear to have two factors resulting in the wrinkles under the eyes. You appear to have a roll of tissue which is hypertrophy of the orbicularis oculi muscle. If treatment is desired, a couple units of Botox is often sufficient to improve this. Too much can result in a sagging appearance of the lower eyelid. This feature can be seen as youthful, however, and not all people appreciate the change when it isn't present. Resection of the muscle is possible, but healing is unpredictable and can result in permanent lower eyelid malposition.

Some of the excess skin could be treated with laser resurfacing to help tighten it. Additionally, skin excision can be performed, but requires an experienced surgeon to avoid eyelid malposition due to scar contracture.

Some Botox, or similar, would improve the crow's feet as well.

Yes, a lower lid bleph with a skin pinch would help smooth out these wrinkles. Maybe a TCA peel as well for the finer wrinkles. This can be done in the office under local anesthesia.

At least from the one smiling photo provided, it would appear that a trial of microtox Botox (I.e. a couple of microdroplets of Botox right in the "belly" of the under-eye muscles) would help to diminish the dynamic wrinkles seen here, without any need for surgery with its expense, downtime, and risks for infection and scarring. You would be wise to consult with a board certified cosmetic dermatologist injector expert. Hope this helps and best of luck.

A repeat lower blepharoplasty can help reduce excess skin, but it may not fully address fine wrinkles around the eyes. For wrinkles and crepey skin, non-surgical options like alaser resurfacing, microneedling with RF, or chemical peels are often more effective. These treatments stimulate collagen production and improve skin texture. Consulting a specialist will help determine the best approach for your goals.

When we smile, the zygomaticus muscle lifts the cheek, creating a skin redundancy.
When we’re young and have good skin elasticity, the elasticity can absorb the skin redundancy.
As we age, we lose elasticity and wrinkles form during dynamic movement, creating skin redundancy.
The problem is not eliminated by trying to tighten the skin of the lower eyelid with a blepharoplasty.
Attempts that will not lift up the skin, but will pull down the eyelid itself, creating a premature ectropion. Most people will eventually develop a senile ectropion from old age.
Having had skin with or without orbicularis muscle removed during a lower eyelid, blepharoplasty tends to advance this happening at a younger age.
For this reason, I typically resist the temptation of trying to tighten the lower eyelid skin by removing skin during lower eyelid blepharoplasty surgery.
The best way to minimize the advancement of facial wrinkles is to protect the skin from sun damage by avoiding excessive sun exposure and wearing daily sunscreen.
Best,
Mats Hagstrom MD