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

Hi, it’s hard to tell how puffy you are without seeing any “before” pictures. From your posted pics, it looks like you had a great outcome. It’s possible you’re hoping for a different look than what you got. That’s typically a matter of having proper expectations. Give it a full year then revisit your original surgeon.

This is caused by how your surgery was designed and executed. To be specific you have a high crease. Assuming you did not get a recent Botox treatment that might affect the forehead, you have a compensatory brow lift. Botox can also cause this but if you have not had Botox, all of this is caused by partial or complete central levator disinsertion. That disinsertion was likely there before the surgery but it needed to be addressed at the time of surgery to stabilize the upper eyelid. The tendon that raised the eyelid also tensions the eyelid platform skin and muscle with the use of a technique to make a hard upper eyelid crease called anchor blepharoplasty. It appears that your upper eyelid incisions are made too high and too much skin an orbicularis oculi were left below the eyelid crease. This can be helped with revisional eyelid surgery. You need crease lowering, correction of the position and insertion of the anterior levator aponeurosis, anchor blepharoplasty and upper eyelid fold reconstruction. Experience counts with these revisions. Your eyes can be your best feature.

At six months post op you are essentially seeing your final result as not much more change is expected. If you are still having swelling I encourage you to visit with your surgeon to discuss your concerns. She/He is most familiar with the details of your surgery and how you've been progressing through recovery.

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