Complications of Blepharoplasty

When preparing for an eyelid lift procedure, it is important that the informed patient understands the potential risk involved with such an operation. In general, true complications are rare in experienced hands, but not nil. An experienced eyelid surgeon will understand how to minimize risks and if a problem does arise, he will be able to recognize and treat appropriately. When undergoing eyelid lifts, one has to distinguish between normal aspects of the recovery and true complications.

What are common experiences after eyelid surgery?

  1. There will be puffiness (a.k.a. edema) and bruising (a.k.a. ecchymosis). Unfortunately, there will be no way around this. 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. Some people heal quicker; other people bruise easier.
  2. 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 lid skin is the thinnest of the body which results in superior healing. The additional expertise of your eyelid specialist will ensure a superior outcome.
  3. The lids and lashes will feel numb. This is usually a temporary situation which is present after every blepharoplasty but not noticed by every patient. Sensation of the eyelids during mascara and eye make-up application may not be normal. This should be more an interesting than a troubling observation.
  4. The vision may be blurry. Especially in the early days after an eyelid procedure, vision may be slightly altered. There may even be some double vision after lower blepharoplasty. These experiences should be short-lived and will correct themselves.
  5. The lids may feel heavy or tight. These sensations are common after eyelid lifts. They correct themselves usually over a few weeks.
  6. The eyes may feel irritated. A common sensation after blepharoplasty (especially of the upper lids), this 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.
  7. Little white bumps may develop along the healing incision line. These can represent little blocked glands and are also called milia. Although small milia usually disappear spontaneously, your plastic surgeon may help it along by treating them with a tiny needle.

Infections after Eyelid Lifts

Infections after blepharoplasty is a rare occurrence with reported rate rates ranging from 0.2 to 0.9%. Some plastic surgeons do use prophylactic antibiotics, others do not. An infection may present with increased redness, swelling and pain often 8 to 10 days after surgery. An infection is usually treated with antibiotics; sometimes infection fluid will need to be drained.

Bleeding associated with Blepharoplasty

Although the lids boast a rich blood supply, bleeding during an eyelid lift is usually minimal. Most commonly, oozing after an eyelid lift is due to leakage of small blood vessels which results in bruising; sometimes more than expected. This has usually no significant impact on the aesthetic outcome although the “black and blue” may take longer to disappear. In rare instances, a blood collection under the skin has to be removed by your plastic surgeon: either with the help of a needle or by opening the incision. The most severe bleeding complication is bleeding into the depth of the eye socket, a condition called retro-bulbar hematoma. Because this complication can jeopardize the patient’s vision (see below), it represents an emergency and should be treated right away.

Scarring after Eyelid Surgery

A routing eyelid lift leaves usually a pencil-fine scar line which is barely noticeable, even to the trained eye. Therefore, it is rare that scaring creates truly cosmetic or function problems. If this happens, a touch-up procedure may be required. Very rarely, over-active scar production (a.k.a. hypertrophic scaring) may lead to unusual appearances of the eyelid including additional folds or “webs”. If these do not resolve with conservative measures, secondary procedures may become necessary.

Asymmetries of the Eyes

Because human faces are not symmetrical, minor asymmetries are normal and usually acceptable after eyelid surgery. More pronounced asymmetries may be the result of unrecognized brow droop on one side, asymmetrical removal of tissues during the eyelid lift or unusual healing that result in bothersome asymmetries. If eyelid asymmetries develop, they can often be corrected with a touch-up procedure.

Incomplete Lid Closure

Incomplete closure of the eyelids (a.k.a. lagophthalmos) may be observed after an upper eyelid procedure. If this occurs early in the recovery, an improvement or normalization can still be expected over the first year of the procedure. Full lid closure is important for proper eye hygiene and health. Therefore, other protective measures including lubrication with eye drops and ointments, taping of the eyelid at night etc. may become necessary parts of the management. If the inability to close the eyes leads to problems, reconstructive eyelid surgery may become necessary.

Droopy Lower Lids after Lower Blepharoplasty

Because the lower lids stand partially upright against gravity, they require enough support to do so. Many factors determine the tightness (support) of the lower eyelids including aging, trauma, surgery and the overall genetic condition. Ectropion is the pulling-away of the lower lid from its normal position on the globe (eyeball). Sometimes, this is a temporary condition which will improve to normal with resolution of the puffiness. If this is not the case, additional procedures may be necessary to tighten the eyelid.

Need for Further Surgery

Whenever a surgical procedure is performed, there is the potential that a touch-up or revision surgery is necessary for the appropriate outcome. Although rare, this also holds true for eyelid lifts. In most experienced hands, the revision rate will be less than 1%.

Vision Impairment after Cosmetic Eyelid Lift Procedures

This is the most devastating complication associated with eyelid lifts. Reports in the literature put this risk at 0.04%. Because these rare cases have been affecting one eye, most surgeons will not perform cosmetic eyelid surgery on people with only one seeing eye. Vision loss is usually the result of bleeding into the depth of the eye socket that is not addressed readily and appropriately. Experienced eyelid surgeon will be able to recognize this complication and treat it appropriately which will likely save the eye.

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