Complications after Blepharoplasty

Chris Thiagarajah, MD
Article by
Washington DC Oculoplastic Surgeon

There appears to be a great deal of inquiry into the complications after upper and lower eyelid blepharoplasty so this article was written to address those issues:

What are the complications of blepharoplasty? The complications below are not listed in frequency or importance but give a comprehensive list of the possible problems.

1. Asymmetry: When blepharoplasty is performed on the upper or lower eyelids there can be asymmetry in the correction. Sometimes an unequal amount of fat or skin can be removed from either side. Usually there was an underlying asymmetry between the two sides and more skin or fat was not removed from the worse side. This can usually be fixed with a small touch up procedure. 

2. Inability to close the eyelids: Removal of excess skin can result in inability to remove the eyelids. This is uncommon but usually temporary. Over 1-2 months the eyelids stretch back into position to allow closure. Artificial tear drops and lubricant can compensate in the meantime as things are healing. 

3. Exacerbation of dry eye: Inability to close the eye may exacerbate a dry eye condition. Additionally, removing skin the eyelids can slightly increase the eyelid aperture or how wide the eye is in a resting state. This increases the evaporative surface and can make dry eye problems worse.

4. Infection: A rare complication after eyelid surgery. Antibiotic ointment is given after surgery and should be used as directed

5. Scarring: Irregular wound healing or scar formation can occur. This may be fixed with a touch up procedure.

6. Lower eyelid retraction: In a lower eyelid blepharoplasty, lower eyelid retraction (the eyelid being pulled down) can result. This can occur when skin is or isnt removed. This may necessitate further surgery. In rare circumstances skin grafts have to be placed. 

7. Vision Loss: This is the most feared complication during blepharoplasty surgery though this is rare. Intraoperatively there can be inadvertant damage to the eyeball itself however more commonly there can be bleeding behind the eye after surgery resulting in damage to the optic nerve (nerve that supplies the eye). 

8. Bleeding: after surgery, there can be bleeding. If it is severe it is important to inform your surgeon immediately. Bleeding behind the eye can cause permanent vision loss. Light discharge or  drainage is normal and can be stopped with pressure for 5 minutes. 

9. Double vision: Occasionally, double vision can result from indirect damage to the muscles that control eye movement. Usually this resolves with time but may necessitate eye muscle surgery or prism in glasses. It is an uncommon risk of the procedure but can happen

10. Delayed bruising and swelling healing: Healing usually takes 2 weeks for most swelling to be gone. That being said, people are on a bell curve and there are extremes. There are some people that take up to 1 year to completely heal. From a microscopic pathology perspective complete healing takes 1 year but the noticeable changes that most people see when they look in the mirror take about 2-3 months though over the first 2 weeks most people are 90% back to normal.

With any surgery there are the more common complications (listed above) but there are also remote risks. For example if your surgeon is operating and there is an earthquake and the surgical light falls from the roof and breaks your arm. These are very remote and usually are not needed to be reviewed before surgery as there are as many as your mind can imagine.