Risks associated with blepharoplasty surgery may be grouped into anesthesia risks, and surgical complications. Anesthesia risks are common to any surgery and are discussed elsewhere. Events such as cardiac complications (heart attacks or myocardial infarctions), allergic or anaphylactic reactions, lung-related adverse effects (pulmonary embolism, pneumonia), kidney, liver, or any other organ system problem would all fall under that category. Complications related to the act of surgery may be grouped into risks involved in undergoing any procedure, and risks particular to blepharoplasty or brow lifting. Risks of any procedure include bleeding or hemorrhage, infection, whether skin, soft tissue, abscess, or necrotizing, acute and chronic pain, and acute or chronic skin sensitivity. Delayed healing is more common is persons with vascular disease and smokers. Fluid collections known as seroma may occur in the dissected space, this typically resolves with fluid drainage. Fine results are anticipated but never guaranteed. Dissatisfaction with the cosmetic outcome of any procedure will require procedural correction.
Complications related to specifically to blepharoplasty surgery include asymmetry, which may need surgical correction through re-operation, inadequate correction of the excess skin, over-correction of the lids leading to an inability to close the lids (which may lead to its own problems with the cornea, tearing, dryness, etc. and is usually a result of a combination procedure with upper blepharoplasty – persistent symptoms of this nature may require surgical reconstruction). Alopecia, or hair-loss around the incision is not a frequent complication, but is not rare, and my necessitate hair replacement or re-positioning for correction when blepharoplasty is combined with browlifting. Contour abnormalities, divots, lumps, bumps, wrinkles may result from a blepharoplasty surgery. When presenting weeks after surgery, irregularities may be a result of internal scarring. They typically resolve without issue, but may need correction in some cases. Recurrence of the upper lid skin excess droop is also a common negative outcome in eyelid surgery, in which case additional skin must be excised. “Dog ears” are more of a possibility with the open approach, and may also require secondary correction. Scars are not particular to the blepharoplasty procedure, but their prominence, or asymmetry if present, after this procedure may be hard to mask, and may require revision blepharoplasty surgery or other means of making the inconspicuous. Blindness is caused by pressure due to bleeding into the eye-socket, and is exceedingly unusual. Bleeding around the eye is a true surgical emergency and needs prompt decompression. Damage to the muscles that move the eye (especially the inferior oblique) is also a possibility. This would necessitate prompt repair, and in the case of a delayed diagnosis a reconstruction at a later time. Dryness of the eyes may be exacerbated or unmasked by blepharoplasty surgery. In spite of certain pre-operative tests and a thorough history, it may not be avoided. Ectropion, (an out and down dislodgment of the lower lid from the eyeball), scleral show (drooping lower lid), lid irritation, and at times entropion, may be caused by lower lid blepharoplasty. This may require further surgery for failure to resolve within several months. Difficulty closing the eyelids, owing to scar contracture may necessitate surgery to prevent permanent damage to the corneae. Eyelid hair-loss is typically temporary if it occurs, but if lashes fail to grow back within 4-6 months, surgery may be warranted. Transient swelling at the corners of the eyelids is quite common, and more so when upper and lower lid work is combined. This is usually self-limited, but takes several weeks to months to resolve.