Is it true that there won't be any internal bleeding in an eyelid surgery when the fat is not removed?

When the fat in the upper or lower lids are not removed and used for the eyelids then there won't be any internal bleeding which can cause blindness. Is the true?

Doctor Answers 6

Not true

Any time you violate the orbital septum or operate behind the septum, you can cause internal bleeding which can potentially lead to blindness IF LEFT UNTREATED. This is an important point because eyelid bleeding leading to orbital involvement enough to cut off circulation to the eyeball happens over time and causes a progression of symptoms which should be obvious (i.e. severe pain, acute swelling, severe bruising, double vision, proptosis, loss of vision). Effective treatment exists in the acute setting before the loss of vision is irreversible if the surgeon is made aware of the problem. This is what oculoplastic surgeons train for and know how to reduce the risks of. I discuss the symptoms which should prompt my patients to call me directly on my cell phone for this reason.

So the only way to guarantee zero risk of internal bleeding is the operate on the skin only (which is often done for the upper lids).


Fresno Oculoplastic Surgeon
4.9 out of 5 stars 31 reviews

Is it true that there won't be any internal bleeding in an eyelid surgery when the fat is not removed?

Blepharoplasty is a surgery to improve the appearance of the eyelid by addressing symmetry, shape, size, redundant skin, or herniating fat. 

Depending on the technique, the risk for internal (orbital) bleeding varies. Fat removal or fat repositioning expose the patient to a low risk of bleeding in the orbit. Removal of skin or muscle alone does not put the patient at risk for bleeding in the orbit. 

I would ask your surgeon what technique they plan on using, so you can understand the risks of the procedure. Safety comes first. 

Victor Chung, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

This is not an accurate statement.

What is true is that fat removal increases the risk of bleeding that can endanger the vision.  The risk of this complication even when fat is removed is rare.  There is not a precise number for how often this occurs but it does occur.  A reasonable estimate of retrobulbar hemorrhage leading to visual loss is approximately one in 50,000 to 100,000 cases.  For this reason, it is essential to follow your surgeons recommendations on avoiding things that can thin the blood.  Even without fat removal, any surgery on the eyelids could lead to bleeding that might threaten vision but these risks will be lower.  It is appropriate to be concerned about these risks and let the risk guide the choice of eyelid surgery.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

Bleeding with blepharoplasty

Even with injection of local anesthetic there can be bruising and bleeding. Problems other than bruising with surgery however are very rare. The less dissection around the eye (for instance not invading the orbital septum) will reduce the incidence of bleeding.  I usually do most of my blepharoplasty surgery with the laser which seals vessels, thus reducing the bleeding.

Richard O. Gregory, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 11 reviews

Is it true that there won't be any internal bleeding and eyelid surgery when the fat is not removed

False. Any time surgery is  done, they can always be bleeding. Repositioning of lower eyelid fat requires more surgery than simple removal, therefore has a higher incidence of bleeding. The chance of blindness after a blepharoplasty is exceedingly rare. Choose your surgeon based on extensive experience for best results

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 reviews

Pretty much yes

So it depends on the lid and depends on the technique but if the orbital septum is not divided, then its very unlikely to get orbital bleeding. 

The risk of bleeding and blindness after this type of surgery in general is only 0.045% so very very low but the orbital septum is the key structure. There are lower lid techniques where the fat is repositioned, not removed and this may still result in bleeding so ask your surgeon carefully what they are planning if you want a specific answer to your question. 

Hope that helps. 

Adam Goodwin

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.