Eyelid Surgery Risks

What are the risks of upper eyelid surgery?

Doctor Answers 30

Most important and common risk of eyelid surgery

Dear Alexa

Please don't let anyone rush you into eyelid surgery because it is simple and straight forward. My colleagues have done a good job describing the textbook issues that can arise after upper eyelid surgery.

However, by far the most common and most important potential complication is a failure of communication between you and your surgeon. You go to the doctor and you might even ask for an upper eyelid blepharoplasty. However this may or may not be what you need. The doctor might even agree to preform eyelid surgery, after all the surgeon may consider this a very simple procedure.

Here is the issue: is this what you need? Most people assume that they need eyelid surgery when the upper eyelid fold hangs onto the eyelid platform or eyelashes. Due to how the brain is wired, the upper eyelid fold is supported by activity in the forehead lifting muscles that raise the eyebrow. When upper blepharoplasty is performed, the skin resting on the eyelid is removed and so is the signal for the forehead muscle to activate. The forehead relaxes and the eyebrows fall. This can make the eyes look smaller after upper eyelid surgery. In this circumstance, the correct surgery is not upper eyelid surgery but rather an endoscopic forehead lift.

Another area for disappointment is loss of the upper eyelid fold itself. Many surgeons will resect all the available upper eyelid fold while still permitting the eyes to close. This is generally a big surprise to the patient. The upper eyelid fold is a very important aesthetic feature of the face. The unexpected loss of this important feature can lead to long term disappointment with the surgery. The surgeon often does not understand why the patient is unhappy with surgery because to their thinking, this is what eyelid surgery is supposed to accomplish. However, the answer here is that most people would preserve the fold but have it cleaned up if they had been given the choice. It is possible to do very elegant eyelid surgery and yet leave the upper eyelid fold.

Other areas of disappointment include the placement of the upper eyelid crease too high. The plastic surgery textbooks routine describe making the lowest upper eyelid incision 10 mm above the eye lashes. However, this is much too high. Normally in women, the natural upper eyelid crease is actually located at about 8 mm. However, when an incision is made, the final location of the incision will be 1 to 2 mm higher than intended due to how the eyelid heals. So the 10 mm incision heals to a 12 mm height. This is a very bad thing. It is much safer to place the incision at 6 or 7 mm.

Also, it is important to put the eyelid platform skin on slight stretch. This tension helps support the upper eyelid lashes so they perk up after surgery rather than point down. This maneuver is called anchor blepharoplasty. To perform it, the eyelid platform skin needs to be attached to the tendon that raises the upper eyelid. This requires a specialized knowledge of eyelid anatomy that most eyelid surgeons lack.

So the biggest risks of the surgery come from a lack of a detailed and systematic approach to performing eyelid surgery, through consultation and communication. If you spend less than 5 minutes with your potential eyelid surgeon, this should be a big red flag.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Risks of Upper Blepharoplasty

Of upper and lower Blepharoplasty, the procedure on the upper eyelids has the fewest major risks. Probably the two greatest risks are recurrence of the problem and chemosis or dry eye. It is possible to remove too much skin and have the eyelid elevated. However, because of gravity, this is uncommon. Gravity can, however, when combined with the pull of the blepharoplasty, cause brow descent, returning extra tissue to the eyelid and depressing the arch of the brow. Chemosis (inflammation of the conjunctiva – the covering of the eyeball) and dry eye are more common (20%) when both eyelids are done, but also occasionally a problem with just upper blepharoplasty. This usually resolves easily with drops. One of the other problems is skeletonization of the eyelid and brow. This occurs when too much fat is removed. To prevent this you need to talk to your surgeon about your desires and his/her cosmetic perspective. Of course, anything that can happen with any surgery up to even death is possible, but quite rare. Overall, this is an excellent operation that has a very good ratio of risk to benefit.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 6 reviews

Many upper eyelid surgery risks which will be better defined in your consents

Whenever you have a procedure, such as a blepharoplasty (eyelift / eye lift / eye cosmetic surgery / eye plastic surgery / eyelid lift), from a legal standpoint they will list everything under the sun. The key is going to someone that has a low rate of complications. But briefly, eye damage, damage to organs, nerves, vessels, poor results, scarring, eyelid malformations, infection, bleeding, anesthesia risks are among the risks that most surgeons should have in their consents. 99.9% of the time complications don't happen.

Thanks for reading!

Philip Young, MD
Bellevue Facial Plastic Surgeon
4.2 out of 5 stars 84 reviews

Risks of upper blepharoplasty

Over correction is the most common complication. This could result in poor eyelid closure, an artificial appearance, sunken upper eyelids, elevated lid crease and dry eyes. Asymmetry is another relatively common problem. In addition, if the surgeon does not recognize certain issues before surgery, the results will be poor afterwards. This includes eyebrow ptosis (drooping), eyelid ptosis and lower eyelid abnormalities. You should see an eyelid specialist (oculoplastic surgeon) for evaluation and for a treatment plan tailored to your specific issues. 

James R. Gordon, MD, FACS, FAAO
New York Oculoplastic Surgeon
5.0 out of 5 stars 140 reviews

Upper Blepharoplasty Risks

Thank you for your question. As with any invasive procedure, there is a minimum amount of risk attributed. As a board-certified facial plastic surgeon I advise patients briefly the common blepharoplasty risks which are: eye damage, vessel laxity, scarring, eyelid malformations, infection, irritation, bleeding, and anesthesia complications.  In terms of Upper Blepharoplasty procedures, the most common issue listed would be Overcorrection. An overcorrection of the delicate upper eyelid can often result in poor eyelid closure, sunken upper eyelids, and an elevated lid crease which can provide a ‘surgical’ appearance. Another potential risk would be Asymmetry. The best step to combat such risks would be for your surgical professional to note eyelid drooping and abnormalities prior to the procedure being performed in order for a more tailored procedure with less risks. Good luck

Sam Rizk, MD
New York Facial Plastic Surgeon
4.7 out of 5 stars 73 reviews

Eyelid Surgery Risks

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

Eyelid Surgery Risks

The risks of blepharoplasty are minimal but excessive swelling, persistent fat or loose skin, dry eyes, and rarely visual loss have been reported.

Jose E. Barrera, MD, FACS
San Antonio Facial Plastic Surgeon
5.0 out of 5 stars 46 reviews

Eyelid Surgery Risks

Hi there.  This is a very important question.  It is possible to list all the risks to eyelid surgery here.  In my opinion, though, this information should come from your surgeon.

Select a surgeon whom you feel comfortable with, one who answers all of your questions to your satisfaction and is able to show you multiple before and after photos of patients with concerns similar to yours.  I hope this is helpful.  Good luck.

Anand G. Shah, MD
San Antonio Facial Plastic Surgeon
4.5 out of 5 stars 13 reviews

Complications Following Blepahroplasty

                  Complications following blepharoplasty surgery are fortunately uncommon. This procedure is associated with high patient satisfaction rates and low complication rates.

                  Complications seen with blepharoplasty include infection, bleeding, hematoma, asymmetry, excess scarring, injuries to the eye, blindness and dry eye syndrome.

                  In addition, rarely patients have less then optimal aesthetic results which requires secondary surgery.

                  It’s important to understand that the majority of patients have uneventful recoveries and are extremely happy with their aesthetic results. 

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 194 reviews

Risks of Upper Eyelid Surgery

Take some time looking on Realself about how to select a plastic surgeon to start. One common problem I often see with upper eyelid surgery is the removal of to much skin and fatMy approach to upper eyelid surgery is to be conservative with skin excision, and to reserve excision of fat for patients with significant fat excess. In my opinion, aggressive removal of upper eyelid skin and fat is a 'skeletonizing' procedure which risks making eyes appear more deep-set and aged, rather than younger. In fact, in many patients I perform structural fat grafting (using the patient's own fat, from the abdomen or hips) to help restore soft tissue volume around the eyes.
The next time you flip through Vogue or Allure (guys, just grab one at the checkout stand) take a close look at the eyes of the models. In most of them, women in their teens and twenties, you will see only a sliver of the upper eyelid, if it is visible at all. In many, the upper lid is completely obscured by soft tissue fullness between the brow and eyelashes, which I sometimes refer to as the 'brow roll'. Perusing the fashion magazines provides quick confirmation that the youthful upper lid is not a skeletonized upper lid.
Structural fat grafting provides a mean for restoring or enhancing this 'brow roll' area. In patients that have always had, or who with age have developed a deep recess between the upper lid and brow, the addition of soft tissue volume can dramatically rejuvenate the appearance of the eyes. This novel aesthetic enhancement of the upper lids does not look like eyelid surgery – it just looks youthful.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 118 reviews

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.