Anyone considering surgery should approach the decision with a healthy amount of respect and caution especially when the surgery is elective (or planned) and is non essential surgery (as aesthetic or cosmetic surgery generally is). All surgical procedures have limitations in terms of achievable outcomes and it is important that your expectations match what is possible through surgery. The choice to go ahead with surgery is always (or should always be) taken after due consideration of the risk benefit balance for the procedure. Although the majority of patients do not experience problems it is important that you fully understand all the potential risks and complications of blepharoplasty surgery. It is important that you take the time to read over them again prior to your next consultation.
Bleeding
It is possible, though unusual, to experience a bleeding episode during or after surgery. Bleeding may occur under the skin or internally around the eyeball. Intraoperative blood transfusions may be required. Should post-operative bleeding occur, it may require emergency treatment, surgery, or blood transfusion. Do not take any aspirin or anti-inflammatory medications for ten days before or after surgery, as this may increase the risk of bleeding. Non-prescription “herbs” and dietary supplements can increase the risk of surgical bleeding. Hypertension (high blood pressure) that is not under good medical control may cause bleeding during or after surgery. Accumulations of blood under the eyelids may delay healing and cause scarring. Hematoma can occur at any time following injury. If blood transfusions are needed to treat blood loss, there is a risk of blood-related infections such as hepatitis and HIV (AIDS).
Heparin medications that are used to prevent blood clots in veins can produce bleeding and decreased blood platelets.
Blindness
Blindness is extremely rare after blepharoplasty. However, it can be caused by internal bleeding around the eye during or after surgery. The occurrence of this is not predictable.
Infection
Infection is unusual after surgery. Should an infection occur, additional treatment including antibiotics, hospitalization, or additional surgery may be necessary.
Scarring
All surgery leaves scars, some more visible than others. Although good wound healing after a surgical procedure is expected, abnormal scars may occur within the eyelid and deeper tissues. Scars may be unattractive and of different color than the surrounding skin tone. Scar appearance may also vary within the same scar. Scars may be asymmetrical (appear different on the right and left side of the body). There is the possibility of visible marks in the eyelid or small skin cysts from sutures. In some cases scars may require surgical revision or treatment.
Damage to Deeper Structures
There is the potential for injury to deeper structures including, nerves, blood vessels, eye muscles, and lungs (pneumothorax related to general anaesthesia) during any surgical procedure. The potential for this to occur varies according to the type of blepharoplasty procedure performed. Injury to deeper structures may be temporary or permanent.
Dry Eye Problems
Permanent disorders involving decreased tear production can occur after blepharoplasty. The occurrence of this is rare and not entirely predictable. Individuals who normally have dry eyes may be advised to use special caution in considering blepharoplasty surgery.
Asymmetry
The human face is normally asymmetrical (eye shape, eye socket position on the face and the degree of soft tissue laxity and excess). There can be a variation from one side to the other in the results obtained from blepharoplasty surgery and this is within the normal outcome spectrum for this procedure. Additional surgery may be necessary to attempt to revise significant asymmetry.
Pain
You will experience pain after your surgery. Pain of varying intensity and duration may occur and persist after blepharoplasty surgery. Chronic pain may occur very infrequently from nerves becoming trapped in scar tissue (neuropathic pain).
Ectropion
Displacement of the lower eyelid away from the eyeball is a rare complication. Further surgery may be required to correct this condition.
Corneal Exposure Problems
Some patients experience difficulties closing their eyelids after surgery and problems may occur in the cornea due to dryness. Should this rare complication occur, additional treatments or surgery and treatment may be necessary.
Allergic Reactions
In rare cases, local allergies to tape, suture materials and glues, blood products, topical preparations or injected agents have been reported. Serious systemic reactions including shock (anaphylaxis) may occur to drugs used during surgery and prescription medications. Allergic reactions may require additional treatment.
Eyelash Hair Loss
Hair loss may occur in the lower eyelash area where the skin was elevated during surgery. The occurrence of this is not predictable. Hair loss may be temporary or permanent.
Delayed Healing
Wound disruption or delayed wound healing is possible. Some areas of the skin may not heal normally and may take a long time to heal. Areas of skin may die. This may require frequent dressing changes or further surgery to remove the non-healed tissue. Smokers have a greater risk of skin loss and wound healing complications.
Change in Skin Sensation
It is common to experience diminished (or loss) of skin sensation in areas that have had surgery. Diminished (or complete loss of skin sensation) may not totally resolve after a blepharoplasty.
Skin Contour Irregularities
Contour irregularities and depressions may occur after blepharoplasty. Visible and palpable wrinkling of skin can occur. Residual skin irregularities at the ends of the incisions or “dog ears” are always a possibility and may require additional surgery. This may improve with time, or it can be surgically corrected.
Skin sag
With any procedure that stretches the skin to achieve a result the skin will respond elastically and stretch. As part of this response in addition to stretching, the skin will also expand so that it is not under tension. This results in a varying degree of recurrence in ‘sagging’ of the skin which varies from individual to individual. The repositioning of the deeper soft tissues that changes the shape of the lids relies initially on sutures to hold the change in position, however long-term maintenance of this change relies on scar formation, the strength of which varies from individual to individual. Thus, the extent of soft tissue correction and durability of improvement produced by blepharoplasty is not guaranteed either in extent of correction or duration of correction.
Skin Discoloration / Swelling
Some bruising and swelling normally occurs following blepharoplasty. The skin in or near the surgical site can appear either lighter or darker than surrounding skin. Although uncommon, swelling and skin discoloration may persist for long periods of time and, in rare situations, may be permanent.
Skin Sensitivity
Itching, tenderness, or exaggerated responses to hot or cold temperatures may occur after surgery. Usually this resolves during healing, but in rare situations it may be chronic.
Sutures
Most surgical techniques use deep sutures. You may notice these sutures after your surgery. Sutures may spontaneously poke through the skin, become visible or produce irritation that requires removal.
Subconjunctival oedema
Delicate tissues of the surface of the eye can become swollen following surgery leading to an appearance of fluid on the front of the eye or small collections of jelly like matter overlying the front of the eye. This condition is usually treated with eye drops and resolves over a matter of weeks, though occasionally further action may be required (for example a sort course of oral steroids, a procedure to drain the fluid build up or temporary stitching to keep the eye closed). Very rarely the problem can persist for a period of months and in isolated cases the problem can be permanent.
Surgical Anesthesia
Both local and general anesthesia involve risk. There is the possibility of complications, injury, and even death from all forms of surgical anesthesia or sedation.
Seroma formation
A seroma can be best thought of a collection of fluid beneath the skin at a surgical site. The composition of a seroma is much the same as that of blood but without the actual blood cells (it contains similar proteins and salts to blood) and is usually the result of lymphatic fluid accumulation (this is the 10% of the fluid that escapes from capillaries within tissues but does not return back to the veins via the small blood vessels but rather by the lymphatic drainage vessels) or by direct production from inflamed tissue (think of the tissues ‘sweating out’ the fluid). If this occurs there is the possibility it will need to be drained (often by simple aspiration with a needle or syringe, though in rarely can require a further operation to remove completely).
Unsatisfactory Result
Although good results are expected, there is no guarantee or warranty expressed or implied, on the results that may be obtained. You may be disappointed with the results of eyelid surgery. This would include risks such as asymmetry, unsatisfactory surgical scar location, unacceptable visible deformities, loss of function, poor healing, wound disruption, and loss of sensation. It may be necessary to perform additional surgery to improve your results. Additional surgical procedures such as a brow lift may be needed to correct eyebrow sagging which contributes to upper eyelid problems.
