Fat pads are starting to show again. Should I have another blepharoplasty? (photo)

i agree that there is trace residual herniated orbital fat. However, the puffiness you see right under your eyelids is actually a muscle (orbicularis oculi) that is responsible for blinking/closing your eye. Some people have more a more pronounced muscle that becomes more apparent after removing the surrounding fat with the blepharoplasty procedure. You can consider botox the muscle to soften/flatten it. You can also consider some skin tightening (such as with laser resurfacing) to smooth out the appearance of the entire lower eyelid area. You can do either of these options with or without a repeat blepharoplasty to remove the residual herniated orbital fat.

Thank you for your inquiry! By your photos, it looks like you would be a great candidate for another lower bleph procedure to remove additional fullness to your lower eyelids. I recommend scheduling a consult appointment with a board certified plastic surgeon like myself so we can assess your eyes, listen to your goals, and create a surgical plan that is best for you and your goals!

Thank you for the question and photos.
I agree with your assessment and it does look like you have some prominence of the lower eyelid fat pads. While surgery can definitely lead to improvements and "turn back the clock" in certain aspects, it cannot stop the progress of time. The good news is that this is likely much less severe than it would have been without surgery and you may be a good candidate for fractional laser treatment instead of another surgery. I think the upper eyelids look good though, so hopefully don't need to address anything there. Your best bet is to schedule a consultation with a plastic surgeon well versed in eyelid surgery/treatments to discuss in person.
Hope this helps!Kyle Kimura, MD

You will likely need a combination of transconjunctival lower blephoroplasty with possible fat repositioning, and fat transfer.

Consult an expert for an evaluation. Contact me for more details! Hope this helps!

Volume deficit in the cheeks, which appears to be the case in the photos provide, plays a major role in the development of under eye problems, such as tear troughs and bags. If this is indeed the case here, this can be quickly and easily remedied with the use of a lifting filler, such as Restylane Lyft. This must be done in the appropriate way to maintain a feminine, heart-shaped face and Ogee Curve while secondarily improving the under eye issues. Belotero Balance could be used subsequently should the infraorbital tear troughs and bags still remain an issue. You would be wise to consider consulting with a board certified cosmetic dermatologist. In experienced hands, treatment should take no more than about twenty minutes and typically gives rise to immediate "Wow!" reactions Best of luck.

It is very likely that lower blepharoplasty, this time transconjuctival without skin removal is needed to achieve improvement. Addition of volume in the upper and lateral cheeks, supraorbital and infraorbital areas by means of fat grafts should be considered as well. Good luck.

I Woukd not recommend another blepharoplasty but rather fat grafting at the junction between the fat lads and the orbital rim: There is a minor to what can be achieved with one transfer because the fat has to regain a blood supply and the tissues are thin.. so for an optimal result a second transfer may be indicated. This procedure can be done as an office procedure much like a filler, but it must be done properly to avoid lumpiness. You do not have excess fat or skin so a lower blepharoplasty would not help you very much.