I am unhappy with my lower bleph results 4 months post. What can I do at this point to achieve better results? (photos)

Your right cheek seems to be more full that the left 4 months after arcus marginalis release surgery.  While this area will continue to change to a small degree, you are not likely to see much change here.  This means that it is reasonable to consider what can be done to make the too sides appear the same.  Donot laser or botox this area.  It will not address the lack of fullness on the left side.  I do not recommend reoperating on the lower eyelid to further adjust the transposed fat-the risk of harm and the low likelihood of successful outcome does not make this intervention warranted.  Your very best option, is likely your very best option before your surgery, which is lower eyelid/top of cheek fillers.  The key is finding a very artful injector to perform your treatment.  They need to very much understand what is bothering you about the cheek.  Restylane is the preferred product for this treatment.  

From the photos provided, it appears that volume loss and inadequate replacement likely account for the tear trough line still present following the surgical blepharoplasty. Since volume depletion is at the heart of the problem, it is hardly surprising then that Botox, which is used to treat hyperfunctional facial expression muscle action and chemical peels, which are used to treat surface discolorations and irregularities, were not helpful in this case. Volume loss requires volume repletion. My choice for this region would be Belotero Balance, since this filler possesses little chance of leading to the unwanted, bluish Tyndall Effect that may be seen when other hyaluronic acid fillers are injected superficially within this thin, delicate region. Smoothing this area in this fashion is nearly painless (contrary to  popular misconception), takes only minutes to perform, and gives rise to results that are typically immediate and gratifying.Consultation with a board certified core aesthetic physician with extensive expertise and experience in injecting the periorbital region is strongly urged.

Thank you for your pictures. I'm sorry that you're unhappy with your results. It seems that you still have fullness of your lower eyelid. This is most likely due to your reposition fat. None of the previous treatments in my opinion are going to correct your issue. The only way to reduce that fullness will be to remove the fat.