How risky is the lower blepharoplasty surgery?

Question

I had an upper blepharoplasty done. My surgeon does not believe in lower eyelid surgery because of the risk of hematomas, and entropion and ectropion. Besides going to a practiced and board certified specialist, can you advise as to how risky this procedure is and if my doctor is being too conservative. If not surgery, what else is available to reduce excess skin. I do not have bulges or deep pockets.

Philip S. Schoenfeld, MD, FACS · Answer

There are definitely risks and potential complications of lower eyelid surgery.  The potential for minor issues following lower eyelid surgery is also higher than many other surgeries.  Your comment ended with the fact that you have no bulges or deep pockets.  Do you think that your surgeon believes that you may not need a lower lid blepharoplasty given the appearance of your eyes and that in your particular case it is not worth even the smallest potential for an adverse outcome?  A photo would be helpful so that I can understand what the status of your lower eyelids are and what issues would specifically need to be addressed.

Kenneth D. Steinsapir, MD · Answer

Lower blepharoplasty is just as safe as upper blepharoplasty.  However, there is no substitute for knowing what you are doing.  Perhaps your current is not being "conservative."  Perhaps they are telegraphing to you a weakness in their training.  I always advise people not to make a surgeon do procedures they are not comfortable with.  While lower eyelid surgeries have have complications, like any surgery, being well trained means being able to safely perform the procedure and minimize the risk of these issues.  I recommend seeking second opinions with well trained oculoplastic surgeons.  I think you will find that this opinion reflects something about your surgeon and not lower eyelid surgery.

John J. Martin, Jr., MD · Answer

What your surgeon may be referring to is that any issues seen after a lower lid surgery can be very obvious to you and to others.  The lower lid is probably the hardest surgery done on the face.  The skin is very thin, so any irregularities in contour are easily seen, and there is normally a fair amount of bruising.  There is also a risk of changing the shape of the eye, ectropion, dry eye, and lagophthalmos.  Therefore one of the most important considerations is finding a skilled surgeon who will know what to do if there are any of these complications - which can occur with any surgeon.  You should seek a consultation with an oculoplastic surgeon.  We have cosmetic training targeted specifically to the eyelid area. If you have no fat to work on the surgery should be pretty straight forward.

Dilip D. Madnani, MD, FACS · Answer

Out of all the facial plastic surgeries done, the lower eyelids require the most finesse.  The risks associated with the surgery are no greater than any other surgery buy achieving great results, as alluded to in the other answers, requires experience. I I don't think it's a fair statement to say that lower eyelids should never be done , if that were the case, I would have many patients who would look fantastic except for their lower eyelids. The questions to ask are 1- would you benefit from such a procedure? This is determined at time of consultation. 2- if you are a candidate, does your surgeon have experience with the procedure ?if the answer to both is yes- then gladly proceed. Good luck!

Brett S. Kotlus, MD, MS, FACS · Answer

The risks associated with lower eyelid surgery are relative and can best be evaluated by taking into account your concerns,  your expectations,  and your anatomy. With an expert surgeon,  such as a fellowship-trained oculoplastic specialist, the complications you listed are somewhat rare.There are nonsurgical options for improving eyelid skin quality including laser resurfacing but you would need a complete consultation first.

Raymond E. Lee, MD · Answer

A lower lid blepharoplasty to correct the under eye "bags" is a fairly common procedure. However, it does need to be done in the right experienced hands of a board certified facial plastic, plastic, or oculoplastic surgeon. The procedure demands good technique and careful patient selection to reduce the above mentioned risks.

Edward E. Dickerson, IV, MD · Answer

There are risks with any surgery, but with experienced surgeons risks are low.  Since you did mention that you do not have bulges or deep pockets, maybe your surgeon did not think it was necessary for you to get a lower blepharoplasty.  A photo would be helpful to understand your status on your lower eyelid. I would advise you to seek other opinions from board certified surgeons in your area.

Suzanne Kim Doud Galli, MD, PhD, FACS · Answer

there are risks to every procedure, yet many patients are treated successfully with lower lid blepharoplasty. You may benefit from an in person consultation with a board certified surgeon with experience and expertise in lower lid surgery.

William B. Rosenblatt, MD · Answer

I don't know what the problem is. I do lower lids, there are risks, but in skilled hands they are very very low.

Robert L. Kraft, MD, FACS · Answer

All surgery carries risks. The lower lid potential complications are as noted. The risks are low but your surgeon would not be conducting a proper informed consent without noting them. If you do not have bulges, then the question would be whether there are sufficient indications for the procedure at this time.

How risky is the lower blepharoplasty surgery?

Answers (15)

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