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What Can Go Wrong with Blepharoplasty?

by Dr. Nicholas Lahar

Blepharoplasty, also called an eyelid lift, is a plastic surgery procedure that removes excess skin, fat, and the muscle above and below the eyes. As we age, the skin and other tissues in these areas can relax and loosen, which may give a tired, older appearance.

In extreme cases, excess loose skin in the upper eyelids can obscure peripheral vision. But an eyelid lift can remove this extra tissue and give the eyes a wider and younger appearance.

Signs that you may need blepharoplasty include:

Drooping and sagging eyelids
Bags under the eyes that don’t improve with a whole night’s sleep
Fat deposits under the eyes
Eyelid wrinkles and excessive skin on the lower lids
Difficulty seeing because of the skin around the upper eyes
A desire to look younger and more awake with wider eyes

A retrospective study of 200 consecutive blepharoplasty patients published in PubMed found an overall complication incidence of 9.5%. The most common issues are chemosis, lower eyelid malpositioning, and hematoma.

Importantly, the study concluded that blepharoplasty demonstrates a high satisfaction rate and a low complication rate. It’s an excellent procedure when properly indicated and performed by a skilled surgeon.

However, blepharoplasty is a complex procedure that can cause issues if it isn’t performed correctly. Below is more information for your consideration.

If you decide blepharoplasty is for you, other procedures can be done simultaneously, including a facelift or breast augmentation.

Contents

1 Blepharoplasty procedure overview
2 Most common Blepharoplasty surgical problems
3 Blepharoplasty risks
4 Request a Blepharoplasty consultation
5 References

Blepharoplasty procedure overview

If you have blepharoplasty on the upper and lower lids, the surgeon typically begins with the upper lids. They cut along the eyelid fold, take out a small amount of muscle, skin, and fat, and then close the incisions.

They make the incision under the lower lashes on your lower lids, either in the crease or inside the lid. Extra tissue and fat are removed, and excess fat under the eye is redistributed to reduce the baggy appearance.

Patients with eyelid skin drooping near the pupils may need ptosis surgery to increase the strength of the eyelid muscles.

According to the American Society of Plastic Surgeons (ASPS), the eyelid lift procedure must be carefully individualized to each patient’s anatomy. Tissue removal is calibrated precisely to achieve a natural, symmetrical result without compromising eyelid function or the ability to fully close the eyes.

Most common Blepharoplasty surgical problems

It’s important to understand that eyelid surgery might look simple, but it isn’t. It’s complex and near the eyes, so several things can go wrong if the surgeon isn’t skilled and experienced. That’s why it’s critical to do your homework when choosing a surgeon.

Excessive fat removed

Removing fat from the upper and lower lids is usually one of the goals of the procedure. But there can be too much of a good thing.

Taking out too much fat, called hollowing, can make the eyes look too open, giving you a startled look. That probably isn’t how you want to appear after blepharoplasty.

A review of blepharoplasty complications published in PubMed warns that over-resection of orbital fat is one of the most consequential aesthetic complications of eyelid surgery. The resulting enophthalmic or skeletal appearance is difficult to correct and may require fat grafting or alloplastic augmentation in revision procedures.

This can be minimized by having a detailed conversation with your surgeon beforehand about the specific results you want and by reviewing before-and-after photos of previous patients.

Conservative fat removal is a guiding principle in our approach to blepharoplasty. The goal is to restore a rested, youthful look that still appears natural. Overcorrection is far more difficult to fix than undercorrection.
– Dr. Lahar

Excessive bruising

Improper surgical techniques don’t necessarily cause this problem. Everyone responds differently to plastic surgery, and you may bruise more than other patients. However, a highly skilled plastic surgeon can often reduce bruising with refined techniques.

On the other hand, a more aggressive surgeon could cause more bruising around the eyes and eyelids. Fortunately, most bruising heals with enough time. But there could be differences in how the eyes look, or you may need longer to recover.

It’s essential to select a surgeon with proven experience and plenty of surgical finesse in eyelid surgeries. As noted earlier, it’s helpful to see before and after pictures of previous patients, so you get an idea of the surgeon’s abilities.

Asymmetry

So, you decided to have blepharoplasty, but the eyes don’t look the same after healing. Asymmetrical eyes or eyelids are a common issue with this procedure.

It may be from the eyelid tissues being too excited by the procedure. Or, your eyes may change in different ways in response to the surgery. A PMC/PubMed review of eyelid malposition after blepharoplasty published at PMC notes that asymmetry is the most common complication associated with lower lid retraction and can occur unilaterally or bilaterally.

Careful preoperative assessment for existing asymmetry is essential to avoid a postoperative surprise in lid position. The surgeon can address asymmetry with revision surgery after you have fully healed.

Some asymmetry can be avoided, but remember it’s hard to say how different sides of the face will heal after the same procedure.

Improper lower lid position

Lower eyelid surgery is delicate, and millimeters can make a big difference in how you appear. Improperly positioning the lower eyelid is a common surgical mistake that can make the eyes two different sizes.

A clinical review published in PMC/PubMed confirms that lower lid malpositioning is the most common complication of lower eyelid blepharoplasty. It is most frequently caused by insufficient lateral canthal support at the time of the primary procedure.

Revision surgery can address the issue after healing for a few months.

Lower eyelid surgery demands more technical precision than upper lid work because the anatomy is less forgiving. In our practice, we routinely assess eyelid tone and canthal support preoperatively. These findings directly shape which technique we use and how much tissue we remove.
– Dr. Lahar

Can’t close the eyes

This is a rare complication, but it’s highly problematic. Not fully closing the eyelids happens if too much skin is removed or incisions are in the wrong spots.

Some patients go overseas for inexpensive eyelid surgery, which can result in. If too much skin is taken out, closing the eyes is difficult.

This is difficult to repair after the skin is taken out. The eyelid skin is the thinnest and most delicate on the body. That’s why highly skilled surgeons are conservative in removing eyelid skin.

If not enough was removed, they can go back in revision surgery and trim a bit more. The Mayo Clinic notes that temporary lagophthalmos is a known risk of blepharoplasty. Patients should monitor their ability to close their eyes completely during recovery and contact their surgeon immediately if this becomes a persistent concern.

Blepharoplasty risks

Other issues can occur from eyelid surgery, regardless of the surgeon’s skill. However, most of the side effects below are temporary and resolve after a few days.

Excessive bleeding or infection
Dry eyes
Scarring
Eye muscle impairment
Discolored skin
Revision surgery required
Temporary blurry vision

There is also a small risk that you could have an adverse reaction to anesthesia. Therefore, the surgeon will consult with you before the procedure to learn your medical history, including allergies to medications and anesthetics.

Blepharoplasty is a popular and effective surgery with excellent results for most patients. If you have concerns about what could go wrong, talk to the surgeon before scheduling the procedure.

Request a Blepharoplasty consultation

Thinking about blepharoplasty in Beverly Hills? Dr. Nicholas Lahar is pleased to provide plastic surgery procedures to his Beverly Hills patients. He will discuss your aesthetic goals during your consultation and help you decide if you are a good candidate for this procedure.