Eyelid Surgery Risks

What are the risks of upper eyelid surgery?

Doctor Answers 25

Most important and common risk of eyelid surgery

Dear Alexa

Please don't let anyone rush you into eyelid surgery because it is simple and straight forward. My colleagues have done a good job describing the textbook issues that can arise after upper eyelid surgery.

However, by far the most common and most important potential complication is a failure of communication between you and your surgeon. You go to the doctor and you might even ask for an upper eyelid blepharoplasty. However this may or may not be what you need. The doctor might even agree to preform eyelid surgery, after all the surgeon may consider this a very simple procedure.

Here is the issue: is this what you need? Most people assume that they need eyelid surgery when the upper eyelid fold hangs onto the eyelid platform or eyelashes. Due to how the brain is wired, the upper eyelid fold is supported by activity in the forehead lifting muscles that raise the eyebrow. When upper blepharoplasty is performed, the skin resting on the eyelid is removed and so is the signal for the forehead muscle to activate. The forehead relaxes and the eyebrows fall. This can make the eyes look smaller after upper eyelid surgery. In this circumstance, the correct surgery is not upper eyelid surgery but rather an endoscopic forehead lift.

Another area for disappointment is loss of the upper eyelid fold itself. Many surgeons will resect all the available upper eyelid fold while still permitting the eyes to close. This is generally a big surprise to the patient. The upper eyelid fold is a very important aesthetic feature of the face. The unexpected loss of this important feature can lead to long term disappointment with the surgery. The surgeon often does not understand why the patient is unhappy with surgery because to their thinking, this is what eyelid surgery is supposed to accomplish. However, the answer here is that most people would preserve the fold but have it cleaned up if they had been given the choice. It is possible to do very elegant eyelid surgery and yet leave the upper eyelid fold.

Other areas of disappointment include the placement of the upper eyelid crease too high. The plastic surgery textbooks routine describe making the lowest upper eyelid incision 10 mm above the eye lashes. However, this is much too high. Normally in women, the natural upper eyelid crease is actually located at about 8 mm. However, when an incision is made, the final location of the incision will be 1 to 2 mm higher than intended due to how the eyelid heals. So the 10 mm incision heals to a 12 mm height. This is a very bad thing. It is much safer to place the incision at 6 or 7 mm.

Also, it is important to put the eyelid platform skin on slight stretch. This tension helps support the upper eyelid lashes so they perk up after surgery rather than point down. This maneuver is called anchor blepharoplasty. To perform it, the eyelid platform skin needs to be attached to the tendon that raises the upper eyelid. This requires a specialized knowledge of eyelid anatomy that most eyelid surgeons lack.

So the biggest risks of the surgery come from a lack of a detailed and systematic approach to performing eyelid surgery, through consultation and communication. If you spend less than 5 minutes with your potential eyelid surgeon, this should be a big red flag.

Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 19 reviews

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Risks of Upper Blepharoplasty

Of upper and lower Blepharoplasty, the procedure on the upper eyelids has the fewest major risks. Probably the two greatest risks are recurrence of the problem and chemosis or dry eye. It is possible to remove too much skin and have the eyelid elevated. However, because of gravity, this is uncommon. Gravity can, however, when combined with the pull of the blepharoplasty, cause brow descent, returning extra tissue to the eyelid and depressing the arch of the brow. Chemosis (inflammation of the conjunctiva – the covering of the eyeball) and dry eye are more common (20%) when both eyelids are done, but also occasionally a problem with just upper blepharoplasty. This usually resolves easily with drops. One of the other problems is skeletonization of the eyelid and brow. This occurs when too much fat is removed. To prevent this you need to talk to your surgeon about your desires and his/her cosmetic perspective. Of course, anything that can happen with any surgery up to even death is possible, but quite rare. Overall, this is an excellent operation that has a very good ratio of risk to benefit.

Many upper eyelid surgery risks which will be better defined in your consents

Whenever you have a procedure, such as a blepharoplasty (eyelift / eye lift / eye cosmetic surgery / eye plastic surgery / eyelid lift), from a legal standpoint they will list everything under the sun. The key is going to someone that has a low rate of complications. But briefly, eye damage, damage to organs, nerves, vessels, poor results, scarring, eyelid malformations, infection, bleeding, anesthesia risks are among the risks that most surgeons should have in their consents. 99.9% of the time complications don't happen.

Thanks for reading!

Philip Young, MD
Bellevue Facial Plastic Surgeon
4.0 out of 5 stars 41 reviews

Upper eyelid surgery risks

As with any surgery, routine risks include pain, infection, bleeding, need for further surgery, damage to adjacent structures, and recurrence of the upper eyelid skin excess. Specific to upper eyelid surgery, risks include damage to the underlying musculature, inability to close your eyes, and corneal abrasions. This list is by no means inclusive of all the risks, but highlights some of the main ones. Be sure to talk to your plastic surgeon about any specific risks that concern you. However, with safety being first and foremost these risks can be kept to a minimum.

Complications Following Blepahroplasty

                  Complications following blepharoplasty surgery are fortunately uncommon. This procedure is associated with high patient satisfaction rates and low complication rates.

                  Complications seen with blepharoplasty include infection, bleeding, hematoma, asymmetry, excess scarring, injuries to the eye, blindness and dry eye syndrome.

                  In addition, rarely patients have less then optimal aesthetic results which requires secondary surgery.

                  It’s important to understand that the majority of patients have uneventful recoveries and are extremely happy with their aesthetic results. 

Eyelid Surgery Risks

With surgery comes risk, this is why it is imperative to go to a reputable Dr. There are risks such as blindness, infection, scarring and bleeding.  Have a consultation with your Doctor and do your research prior to deciding on a Dr.  The risks can be rare, but they can happen.


Edward E. Dickerson, IV, MD
Fayetteville Facial Plastic Surgeon
4.5 out of 5 stars 61 reviews

Eyelid Surgery Risks

Fortunately, most complications following an eyelid lift are minor and self-limiting. Prolonged bruising, swelling, and irritation of the conjunctiva are the most common, minor complications following eyelid surgery.

More serious complications following an eyelid lift include removal of too little or too much skin, cysts at the suture line, or eyelid malposition. Most of these complications can be corrected in a small, revisionary procedure performed under local anesthesia in an office setting.

Jaime Perez, MD
Tampa Plastic Surgeon
5.0 out of 5 stars 37 reviews

Risks of Upper Eyelid Skin Removal (Blepharoplasty)

Upper eyelid blepharoplasty is an extremely safe procedure. As with any surgery, there is a risk of infection, bleeding and scarring. The most common risks include:

  1. Prolonged bruising and swelling
  2. Temporary inability to completely close the eyes
  3. Eye dryness
  4. Need for a touch up to remove remaining skin.

Rarely double vision or loss of vision may occur. All in all, upper blepharoplasty is a great way to improve your eyelid appearance with minimal risk.

You should always discuss all risks in detail with your doctor before proceeding with surgery.

Adam J. Cohen, MD
Skokie Oculoplastic Surgeon
3.5 out of 5 stars 13 reviews

Risks of upper eyelid surgery

Risks of all surgeries no matter what surgery... bleeding scarring infection

These issues are not super pertinent to upper eyelid surgery

The primary risks of upper eyelid surgery are poor cosmetic outcome, need for revision surgery, lagophthalmos (inability to close your eyes all the way)

Risks of any surgery invoving eyelids if fat is resected loss of vision, changes in vision, double vision, excess or inadequate tearing, chemosis (inflammation of conjuctiva)

The vision changes, etc are not commmon, but it must be included in any surgical consent form

Raghu Athre, MD
Houston Facial Plastic Surgeon
4.5 out of 5 stars 46 reviews

Risks associated with upper eyelid surgery

Some of the risks associated with upper eyelid surgery are bleeding and infection, which are very rare. Risks of permanent blindness or double vision are exceedingly rare. Asymmetry is more common; this probably happens 3% to 5% of the time and is usually related to pre-existing asymmetry that has gone unnoticed by the patient until the procedure is performed.

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 60 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.