My eyes look tired 4 years after upper blepharoplasty. What can be done - an eyebrow lift or second blepharoplasty? (photo)

To address this, you need a surgeon who actually understands this syndrome. I have published the only paper on this topic. I have placed a web reference to you can read about this syndrome and how it can be repaired. In short in includes upper eyelid ptosis, eyelash ptosis, high or absent upper eyelid crease, loose crepey upper eyelid platform skin, and compensatory eyebrow lift. Well meaning oculoplastic surgeons may offer you ptosis surgery. However most ptosis surgeons  strongly predisposed to only offer a type of ptosis surgery called a mueller's muscle conjunctival resection ptosis surgery. Four out of 5 ptosis surgeries in this country are performed this way. Unfortunately, this procedure is not good in the setting of PUBS. That is because internally scaring from the blepharoplasty causes the main tendon that lifts the eyelid to centrally disinsert. When this tendon is out of  place the Muellerectomy is not very effective. That under correction means the eyebrows will not relax down, which will be a big part of what you need to help make the eyes look normal again. What you need is an anterior levator resection ptosis surgery, an anchor blepharoplasty, crease lowering, and reposition of anterior orbital fat into the upper eyelid fold. The anchor blepharoplasty is needed to make a hard crease and support the upper eyelid lashes. Also I suspect that you need the lateral canthus repositioned. There is no substitute for a detailed in person assessment. Your eyes can be your best feature.

Your images suggest a mild upper eyelid ptosis. This can only be evaluated correctly in a consultation, since a photo taken slightly from below can also mimic this problem. I addition, there seem to be some volume loss in the upper eyelids and more significant skin excess in the lateral part of the right upper eyelid. Volume restoration can be carried out in the upper eyelid using fat transfer or advancement of the orbital fat if there is still adequate amount available. A change in the lateral contours of the upper eyelids changes the expression of the eyes whether it involves canthopexy or not. If the lower eyelid position is slightly low on straight gaze, a canthopexy to lift the corner of the eyes may also be of benefit.

You may benefit from upper eyelid ptosis surgery and filler. Not sure if another blepharoplasty is needed. Best to have more detailed evaluation in consultation. See an expert.