Upper Blepharoplasty Despite Severe Dry Eyes?

Patients should be carefully evaluated for the cause of their dry eye syndrome.
Often this is done inconjunction with an opthalmologist and a plastic surgeon, particularly one who specializes in surgery of the face and midface.
If postsurgical changes from a lower eyelid surgery are to blame for a dry eye syndrome, there may be help available from a cheeklift procedure with or without canthal reconstruction. Plastic surgeons who specialize in the midface are particularly familiar with this area, and are capable of reconstructing eyelid defects from small to enormous, including entire eyelids, midfaces, microvascular reconstructions, etc.
A plastic surgeon with an artistic eye will also be able to guide you in evaluating facial proportion as a whole, including the cheeks, the eye-cheek junction, brow position, brow aesthetics and should have familarity with the many types of cheek and brow elevation procedures available. Our chapter in Mathes Plastic Surgery on the midface and brow may be helpful with some of these issues (referenced below).
There is no question that the presence of dry eye syndrome should play a role in the decision making preoperatively, but most dry eye patients are still able to have upper eyelid surgery.

It is common for plastic surgeons to ask about dry eyes when contemplating doing upper blepharoplasty surgery on patients. I do agree that it is a relative contraindication and you need to balance your desire to have the surgery with the knowledge that it may make your condition worse. A quantification of the degree of the problem should be reviewed with a Schirmers test as well as the opinion of your opthalmologist regarding having the surgery done.

Dear Christopher
Dry eye syndrome is very common. It is not a reason to avoid eyelid surgery unless there is an exceptional circumstance. Among eyelid surgeons, only fellowship trained eye plastic surgeons are prepared to manage a dry eye and design eyelid surgery for you that is appropriate for your degree of dry eye. Dry eye needs to be actively managed and supported following eyelid surgery. If surgery is properly done, then once the eyes are healed eye comfort should return to its per-operative state. This might take 6 to 8 weeks.
Commonly after aggressive eyelid surgery, the muscle that closes the eye can be damaged or too much skin can be removed making it difficult to close the eyelids. However, these type of complications are associated with aggressive blepharoplasty. Until you have been assessed by a surgeon, you do not know exactly what you need. You may have a heavy upper eyelid fold that would benefit from upper blepharoplasty or a forehead lift, or you might have an actual fall in the eyelid margin, which is called upper eyelid ptosis. Upper eyelid ptosis requires a different type of surgery where the tendon of the muscle that raises the upper eyelid is shortened.
It is worth your while to seek out a fellowship trained eye plastic surgeon who is also board certified in ophthalmology. ASORPS.org maintains a website with a referral resource by location to help you find eye plastic surgeons in your area. This type of surgeon will be able to diagnose your droop eyelid problem and manage your dry eye without having to see a lot of different specialists.