I'm considering having blepharoplasty eyelid surgery next year. What kind of complications might I run into if I get this done? What is the best way to handle it if you do have eyelid surgery complications?
Doctor Answers 66
Blepharoplasty Complications - ASK QUESTIONS to help avoid complications
The most common complication of blepharoplasty is the over removal of fat. The goal is eyes that look youthful, not pulled and hollow.
If you select a very well trained an experienced plastic surgeon who will have an MD anesthesiologist at your bedside during surgery, and the procedure is performed in an accredited facility, you will greatly reduce the possibility of complications.
The unfortunate side effect I see far to often with with eyelid surgery is aggressive removal of excess skin and fat that leaves hollows under the eyes or below the brows. The effect of this kind of surgery can be very aging and unnatural looking. Seek out a plastic surgeon who can share many, many, many before and after images of eyelid surgery that he or she has performed with natural looking results. I often use structural fat grafting to smooth the eye area and fill in hollows.
The following are a few things that can distinguish some surgeons from others
1) Graduating from a top tier medical school at the top of their class.
2) Membership in Alpha Omega Alpha. This is the medical honors society. Alpha Omega Alpha is to medicine what Phi Beta Kappa is to letters
3) Formal surgical training from prestigious medical universities. The minimum number of years of surgical training for plastic surgeons to be bord certified in five years. Some physicians have as many as ten years of formal surgical training. There simply is no substitute for stelar academic and practical surgical training.
4) Very experienced surgeons with meticulous surgical technique and natural looking outcomes will have photgraphic evidence of their work. Patients should be able to view many photos of the surgery of interest, photgraphed from three different perspectives all with similar lighting, distance from the camera and cropping
The elite experience extends beyond the surgeon to the facility, and the surgical team. You should be able to see the surgical theater and know who else will be in the OR with you during surgery. The Joint Commission (JCAHO) is an organization that provides certification to hospital OR's. The Joint Commission and AAAASF are two of the organizations that can provide certification to surgical suites. Some plastic surgeons elect to have their surgery centers dually certified.
The anesthesia experience is critical to a safe and comfortable surgical experience. A board certified anesthesiologist can administer general or MAC anesthesia. My preference is to have a board-certified anesthesiologist at the bedside of my patients for the duration of surgery.
Plastic surgeons who cater to high profile individuals who place a high value on privacy will have a private first floor entrance and exit so patients never need to be in a public lobby or elevator for pre-operative or post operative visits.
The most common complications of blepharoplasty are bruising, asymmetry, unfavorable scarring, hematoma, chemosis (eye irritation) and probably one of the worst rare complicaitons is blindness. It is best to be treated by an expert whether a plastic surgeon, oculoplastic, or ENT.
Complications of blepharoplasty
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There are complications with any procedure and some are specific to a person's medical conditions. With upper eyelid surgery, the main complication to be conerned with is taking off too much skin causing the eyelid not to close. This is easily avoided by marking the skin to be excised before surgery and checking the markings before any anesthesia is given. Other complications include dry eyes, scarring, pain, blindness, and webbing of the upper eyelid. Overall, upper eyelid surgery is very safe and can often be performed with only local anesthesia.
Obviously, the best way to deal with complications is to avoid them. Unfortunately, complications occur even under the care of the most experienced surgeons. When choosing a surgeon, finding one who has technical expertise is the first step to getting a good result. Probably more important is finding a surgeon who is able to deal with complications. Finding a surgeon who deals with other surgeon's complications is often a good starting point. In this way, should you have a complication, you can rest assured that it will be dealt with in the best way possible. The surgery itself is easy to perform; dealing with the complications can be much more difficult.
Generally, upper eyelid Blepharoplasty is a very high satisfaction, low complication type procedure. Lower lid Blepharoplasty has a greater complication rate, but should still be very low in experienced hands.
However, given the question, I will give you the standard run down of complications I explain to may patients (informed consent). Realize that informed consent is a process which allows you to understand exactly what you are proceeding with, not to scare you, but to make sure you are fully educated.
1) Over resection of skin and inability to close the eyes. I explain to patients that this could happen, but is very easy to avoid. I pinch the eyelid skin while the patient is awake to determine the maximum amount of skin I can safely remove. I then take a little bit less than that.
2) Dry eyes. As we age, we produce less and less tears; every patient gets a temporary dry eye syndrome after eyelid surgery and artificial tears are required. A permanent, clinically significant dry eye syndrome is possible albeit rare and probably more related in nature to over-resection of skin.
3) Asymmetry of eyelid creases. Generally speaking, the lower part of the upper lid incision is made along the upper eyelid crease and correct marking of skin and incision placement avoids this problem. This problem is more likely to occur if the surgeon wishes to reset the upper eyelid crease.
4) Unmasking of pre-existing ptosis. If ptosis (droopy eyelid) is not recognized preoperatively, it generally becomes fairly obvious after the surgery.
5) Bleeding, infection ,scarring. Bleeding is minimal. I have never seen an upper lid incision become infected. Upper eyelid skin is the thinnest in the body and typically forms excellent scars.
Lower eyelid Surgery:
I mention most of the complications above first.
1) Lower lid retraction and/or ectropion. This applies primarily to external approaches, not to transconjunctival approaches. However, in my opinion, an external approach is frequently required to address the tissue descent and skin excess seen with the facial aging process. If excess skin is removed without adequate muscle suspension, the lower lid will lose the battle of the scarring process with the cheek. In severe cases, this can lead to ectropion and corneal exposure. This is an avoidable complication based on experience and judicious technique. It is also more likely to occur in revision cases.
2) Loss of Eyelashes. This is possible but very avoidable via judicious tissue handling and incision placement.
3) Loss of vision. This has been described in the literature via case reports; these reports mainly come from the time period where the anti-platelet activity of aspirin was not recognized, and in cases performed where uncontrolled hypertension was not addressed preoperatively. I have never seen this happen in my community but I always mention it so that a patient is fully informed.
Eyelid surgery complications
Shim Ching, MD
Complications of blepharoplasty
Malposition of the lower lid is the most common complication post eyelids surgery. Other rare complications including having dry eyes, and the inability to close the upper lids if too much skin is removed. Permanent blindness or double vision are extremely rare. To minimize these risks, choose an experienced and expert board certified plastic surgeon. Consult with 3 experienced and expert board certified plastic surgeons to understand your options.
Complications with Blepharoplasty
Complications although rare can occur with blepahroplasty surgery. Upper eyelids can include not being able to close the eyes fully, uneven eyelid openings, hollow look from excessive fat excision, scarring and a few others even more serious. Lower eyelid surgery can result in retraction or pulling downward of the eyelid, tearing, scarring, rounding of the corners, change in the shape of the eyes and others as well. Both can result in dry eyes, and problems with vision. These are risks, but the vast majority of people who get this popular procedure are happy. Consider researching an experienced blepharoplasty surgeon who also deals with its complications.
The most important process of your prospective blepharoplasty is choosing your eye lid surgeon very carefully. Consult with and interview a few surgeons and then choose whom you feel most comfortable. Do not let the cost of the procedure be your determining factor in the choice of your eyelid surgeon as sometimes you may get "what you pay for".
Complications with eyelid surgery may occur, but they are extremely rare in the hands of experienced and skilled surgeon. If you have done your due diligence in choosing your surgeon, most likely you will not have any complications, but most importantly, that surgeon will know how to take care of any adverse events.
Good luck and be well.
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.