What complications can come from a blepharoplasty? How do you handle them?

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.
Upper Eyelid:
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.

Great question.  Every patient should be well aware of all possible expected post op recovery outcomes as well as possible complications.  Some normal expected post operative issues after blepharoplasty include swelling and bruising that may last up to 2 weeks.  This may resolve more quickly with icing for the first 48 hours, taking oral and topical arnica, and elevating the head when sleeping for the first week or so.   It is normal to have temporary dry eye symptoms (either the eyes feel dry and ichy, or they may seem watery (watery eyes may be a symptom of dryness).  Using plenty of antibiotic ophthalmic ointment at night and artificial tears during the day will help with this.  Chemosis is when the whites of the eyes become swollen. This may be a post op side effect as well - if you develop chemises, your doctor may prescribe a steroid eye drop. 
Complications may include infection, bleeding in to the orbit (eye socket), worst of all and very rarely blindness.  If after surgery your pain gets worse rather than better, or if you notice increasing pressure, pain in one eye and blurring or loss of vision, these are emergency concerns for which you should call your surgeon immediately and be evaluated in the emergency room.  Blood or clot trapped in the eye socket can increase pressure on the globe resulting in vision loss if the pressure is not released urgently.  

Every medical treatment has risks, and this is true for eyelid surgery as well. Risks of eyelid surgery include bleeding, scarring, dry eye, infection, difficulty closing the eye, corneal abrasion, inadequate (or overzealous) surgical excision of either skin or fat resulting in patient dissatisfaction, eyelid malposition, need for future surgery, anesthesia complications, and more. As long as you choose a well-qualified and well-trained surgeon who can demonstrate experience in the procedures, these risks are generally very low and great results with eyelid surgery are possible.
As with any surgical procedure, if complications do occur, the first step is to notify your surgeon of any concerns and follow their recommendations very closely.
Be sure to see an expert who specializes in facial aesthetic surgical procedures.
All the best,

A blepharoplasty is a wonderful procedure with an amazing outcome and quite low complication. I always perform my signature TBT-eyelift procedure which is a less-invasive and less-traumatic procedure which minimises the risks and complications. Instead of removing the orbital fat which needs a resection/opening of the orbital septum I reposition the orbital fat and leave the septum intact. This septum divides the eyelid from the orbit with its very delicate structures. With the traditional blepharoplasty a major risk is the over-resection of orbital fat which creates a hollow-eye look of the upper eyelid which looks either very operated or even very old (since we loose this fat with ageing). When resecting the orbital fat the lacrimal glands which look similar to the orbital fat could be hurt or removed resulting in a dry eye for life. Bleeding fat might glide back into the orbit after a part was resected and could cause pressure on the optical nerve which can cause blindness. These risks are not involved with the TBT-lift since the septum is not destroyed but only tightened with an external suture. Further complications of an upper eyelift could be a temporary dryness or chemosis (irritation) of the eyes. Risks like conjunctivitis are very rare and more likely occur when an upper and lower eyelift are combined. An assymetric result is very rare but can easily corrected in a minor revision surgery.

These vary from the upper to the lower lid.  The most common is more than expected bruising and swelling.  Chemosis or swelling of the skin of the eye can occur, as can dry eyes. eyelid closure issues, and irritation.  Worse complications are changes in the shape of the eye, pain, chronic redness and tearing.  These are less common unless heling is delayed (rarely occurs).  These are the basics but the discussion requires a lengthy review.  You can go over this with your surgeon prior to surgery.

I am not going to go through a list of technical complications of the surgery, as many of my colleagues have already done so at length. As a blepharoplasty surgeon specialising in revisions and redos, I would like to offer a different perspective.
Although complications like eyelid retraction etc do occur, by far the most common complications are related to the eye surface, particularly dye eye and blepharitis. Blepharoplasty is unique among cosmetic procedures in that most of the surgeons who offer this procedure have no training in ophthalmology. This means that if there is an underlying problem or complication affecting the eye, they have no knowledge of what might be going on, no training in examining the eye and no concept of how to manage or when to refer. 
As an oculoplastic specialist, I have been trained in ophthalmology first, meaning that I have a deep understanding of eye disease. An essential part of the preoperative work up is the actual eye examination which is performed with biomivroscopy and is essential to anticipate potential eye problems. Only an ocloplastic specialist can do this. 
There is no doubt that plastic surgeons have great tissue handling skills etc and can execute the surgery well, but given at they have no undstanding or ability to assess and manage eye problems, I would strongly advise using an oculppalstic surgeon.
To summarise this message, I would say that the complications not really meantioned by others are the most common, which are ocular surface disorders. Theses can lead to chronic discomfort, pain and sometimes visual problems. I have dealt with a huge number of these cases that have been left untreated and could have been anticipated and avoided if carefully examined and prepared before surgery. If you want the confidence of knowing that your eyes are also being taken care of, use an oculoplastic specialist.

Thankfully, eyelid surgery complications are not common, but they do include swelling, irritation, redness, dry eyes, eyelid retraction or ectropion, hollowing of eyes from over aggressive removal of fat, or even blindness.  In the rare case that there is a complication it can usually be managed appropriately and should resolve completely.  Nonetheless, it is imperative that your surgeon be well trained and experience in eyelid surgery, so that these complications can be avoided and managed appropriately.  

There is often some amount of puffiness and occasionally bruising especially if blood thinners have been taken prior to surgery. The extent of both varies depending on the surgical technique and the specific patient characteristics. Although there are certain measures available to speed up recovery, one has to rely to a great extent on the body's ability to heal. There will be "scars". To many the word scar carries almost a disfiguring undertone, but technically, even the most perfectly-healed incision line constitutes a scar. It is extremely rare that the healed incision line after blepharoplasty is aesthetically concerning. The lids and lashes will feel numb. This is usually a temporary situation but not noticed by every patient. The vision may be blurry for a very limited period of time post operatively but usually due to ointment placed in the eyes. .These experiences should be short-lived and will correct themselves. The lids may feel heavy or tight. These sensations are common after eyelid lifts. They correct themselves usually over a few weeks. The eyes may feel irritated. A common sensation after blepharoplasty (especially of the upper lids),  may be due to a change in tear distribution over the surface of the eyes. It usually normalizes over a few weeks but can be improved in the meantime with application of natural tears.

Eyelid surgery is one of the most delicate surgeries we do. There is a long list of "possible" complications. The most common issue is likely small asymmetries, scars, post operative swelling, bruising and skin issues. 

For each of the issue we have ways to deal with the specific problem. For instance for asymmetries we can do small surgeries to make symmetric after healing. For swelling and bruising we use warm compress and have you sleep with the head of the bed elevated. For scars we can laser and treat with scar management treatments. 



The key is to see someone who does a lot of these surgeries who will give you the best care possible. I follow my patients frequently and over a long time period to make sure they and me are both happy with the results.



Hope this helps.



Best of luck,



DrC

The best
way to manage a complication in eyelid surgery is to prevent it by doing your research and finding a Board Certified plastic surgeon with expertise in cosmetic eyelid surgery.  Know before you go!

Thank you for your question.  Complication are uncommon and when they happen they are usually mild and transitional, such as hematomas and chemosis, infection and bleeding, dry, irritated eyes etc. Nonetheless, sometimes they can be definitive such as blindness, or they require new surgical approaches for correction, such as ectropion and eyelid ptosis. These complication prevention or even their forecast starts with careful preoperative assessment (include detail clinical history and careful physical examination).  Also the surgical technique to be used is based on the anatomical changes found and the patient's complaints, always taking into account patient expectation and the real surgical possibilities for cosmetic improvement.  These will suggest why it is best to be treated by an expert whether a plastic surgeon, oculoplastic, or ENT.All the Best!