What are the Risks and Complications of Blepharoplasty?
You should be well informed before the surgery regarding the risks and complications of blepharoplasty.
Following as some of the risks and complications of blepharoplasty:
- Pain and swelling: Although blepharoplasty is a minimally invasive surgery, pain and swelling are common. Pain is managed with preoperative and postoperative medications in addition to intraoperative local or general anaesthesia. Swelling during the postoperative period is managed with cold compresses and iced eye packs.
- Scarring: Most surgeons manage to finish with a faint scar that is covered up by a crease or one that fades with time. Incision lines could become hypertrophied in keloid-prone patients or could become dyspigmented.
- Superficial ecchymosis and haematoma: Bruising during eyelid surgery is a common side-effect and is easily prevented by avoiding anticoagulants, controlling hypertension, and avoiding postoperative trauma, bending and straining. Ice water compresses and head end elevation are simple but effective measures to prevent ecchymosis and haematoma.
- Wound dehiscence: Risk factors such as infection, restless sleepers, and minor postoperative trauma can cause wound dehiscence. Appropriate suture choice and suture placement are the initially steps in preventing wound dehiscence.
- Upper eyelid overcorrection: Overcorrection can result from aggressive or overenthusiastic skin and fat removal, particularly in patients with previous eyelid trauma, skin conditions with tight skin, and Graves’ disease.
- Lower eyelid overcorrection and retraction: These are seen with skin shortage, scarring, cicatrisation of eyelid structures.
- Asymmetry: Asymmetry is the most dreaded complication for any surgeon, particularly on the face. Lid crease asymmetry is common and is easily avoided with meticulous preoperative preparation.
- Diplopia: This is an extremely rare complication and usually easily treated or resolves spontaneously.
- Ocular injury: It can happen due to the proximity of the eyelids to the eyeball. Surgical trauma or laser are commonly implicated.
- Dry eye syndrome: Patients with "dry eyes" often complain of troubling symptoms such feeling of dryness, gritty or foreign body sensation, burning sensation and stinging, soreness, tired eyes, paradoxically, and watering of eyes. Treat with corneal lubrication and observation initially.
- Epiphora and Ocular discomfort: Temporary epiphora or tearing with ocular discomfort during the postoperative period is common and should not cause alarm either for the doctor or the patient. Epiphora is usually caused by an imbalance between the production and drainage of tears.
- Orbital haemorrhage with vision loss: This is a dreaded complication but gratefully it is rare. Recognition and rapid response is key to saving the eye.
- Retrobulbar haematoma (bleeding behind the eye): Bleeding BEHIND (RETRO) can be very serious and could lead to loss of vision; it could occur infrequently following surgery or trauma. Prompt ophthalmic attention is critical. Look for signs of a firm, bulging eye. Symptoms include protrusion of the eyeball and loss of vision.
- Ptosis (drooping of the eyelid): It is sometimes referred to as blepharoptosis. It refers to an eyelid which is droopy and causes loss of vision, especially while reading, headaches, and eyebrow strain. Ptosis is common with upper lid blepharoplasty. Immediate postoperative ptosis is due to eyelid and levator oedema and subsides with time. If it is due to damage to levator aponeurosis, it must be repaired urgently.
- Ectropion (the eyelid turns out): Ectropion is when the eyelid turns outwards and often arises due to excessive removal of eyelid skin.
- Lagophthalmos (eye does not close completely): Patients with lagophthalmos have an inability to close the eyelids completely causing ‘dry eye’ symptoms. This could occur, for instance, in patients with Thyroid eye disease. It could be normal in early postoperative period.
- Other complications include infection, adverse reaction to anaesthesia, dryness and burning of eyes, lagophthalmos and blurring of vision.
- Dry eye syndrome - patients with "dry eyes" often complain of symptoms such feeling of dryness, gritty or foreign body sensation, burning sensation and stinging, soreness, tired eyes, paradoxically, watering eyes. Visit the Dry Eye page for more details. Treat with corneal lubrication and observation initially.
- Epiphora (tearing) - patients with epiphora complain of watery eyes; it is when there is an imabance between production and drainage of tears. Visit the Lacrimal page for more details. Common for the initially few days due to swelling.
- Retrobulbar hematoma (bleeding behind the eye) - bleeding BEHIND (RETRO) can be very serious and could lead to loss of vision; it could occur infrequently following surgery or trauma. Prompt ophthalmic attention is critical. Visit the Trauma page for more details. Look for signs of firm, proptotic eye. Symptoms includes loss of vision.
- Ptosis (drooping of the eyelid) - sometimes referred to as Blepharoptosis. It refers to an eyelid which is droopy. This could cause a loss of vision, especially while reading, headaches, and eyebrow strain. Please click on the Ptosis page for more details. May be due to damage to levator aponeurosis. Must repair primarily.
- Ectropion (the eyelid turns out) - ectropion is when the eyelid turns out. Visit the Lid Malposition page for more details. Often due to excessive removal of eyelid skin.
Lagophthalmos(eye could not close completely) - patients with lagophthalmos have an inability to close eyelids. This could occur, for instance, in patients with Thyroid eye disease. Visit the Lagophthalmos page for more details. May be normal in early postoperative period.