6 months post-op, still puffy. Will I need a revision? (Photo)

The upper eyelid surgery is often used to create a crease or to remove extra skin. Some surgeons will also suspend brow tissue (using a "browpexy"). The edge of your brow that is further from your nose (lateral brow) appears to either have swelling or prominent tissue (sometimes this is due to the lacrimal gland and other times due to the brow fat pad). It is reasonable to use massage 3 times a day for about 1-2 minutes using something to help your fingers glide on the skin (such as Vitamin E oil or lotion). Start by the corner of the eye that is close to the nose and use a motion going upward + backward. If this does not help after 3 weeks, then it is reasonable to look into getting a browpexy.
One article on this is: The Brow Fat Pad Suspension Suture: Safety Profile and Clinical Observations by Dr. Eftekhari et al. published in the journal Ophthalmic Plastic Reconstructive Surgery in 2016.

To make a quality assessment regarding the outcome of a plastic surgery procedure we generally need to see a complete set of proper before and after pictures.
If you don’t have before, and after pictures and ask your surgeon to forward, the pictures they took.
I generally do not recommend people travel long distances for elective surgical procedures.
People do not seem to appreciate the number of patients who will have concerns after surgery, the number of patients who end up needing revisions or that complications actually happened.
Your surgeon is responsible for the outcome of your procedure and you are responsible for choosing the provider.
At six months, your results have been final for quite a while, and are unlikely to change by waiting further.
Your pictures don’t show anything abnormal.
Best,
Mats Hagstrom, MD