Can lower eyelid skin "tighten up" after lower blepharoplasty with fat repositioning?

With all due respect to plastic surgeons colleagues who have responded, your concern is well founded and has nothing to do with the skill of the surgeon. Although fat repositioning lower blepharoplasty has been my "gold standard" lower blepharoplasty for the past decade or more, in older patients that have started to experience skin laxity and wrinkling, repositioning the fat will "deflate the balloon" to some degree and lead to more wrinkle visibility. The skin will not "tighten" over time as there is no stimulus to create more collagen or elastin without a resurfacing procedure. This is usually not a problem for most patients younger than 45 years old, as there is still good skin tone, unless there has been extensive sun damage or smoking damage in young adulthood.
For patients 50 and older, I most commonly recommend a skin resurfacing procedure such as chemical peel or laser resurfacing to address exactly this problem. A skin pinch is an alternative for patients who are concerned with prolonged recovery after a resurfacing procedure which can leave your skin pink/inflamed for a few days to a few months depending on intensity of the resurfacing procedure. A skin-muscle flap with extensive re-draping and excision of skin is reserved for patients with significant excess skin, which is usually older patients with more extensive aging changes.

Having said all that, many patients do not mind a little additional wrinkling, but rather want to address the bags that make them look tired. I have posted a patient from my website who is 46 years old. You can see that after the fat repositioning, his skin does exhibit more wrinkling than prior to surgery, but he is still a very happy and satisfied patient. If your surgeon is experienced in the subtleties of eyelid surgery, as most Oculofacial Plastic Surgeons are, these possible eventualities, and options to address them, should be discussed in the consultation procedures.

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan. It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Hello! Thank you for your question.Without photos It is difficult to make proper evaluation. If you can provide photos from front of your face, from the side of your face and 1 meter away I would be able to make a proper evaluation. Anyway, sometimes after the surgery extra skin may be occur and you need revision surgery. For more fresh and younger under eye area I recommend revision eyelid blepharoplasty and fat injection to under eye area. However, with face-to-face consultation a healthy decision can be make. Best Regards!