Infection: Infection is a risk with any surgery, including surgery on or around the eyelids. Because of the eyelid's good blood circulation, elective surgery performed under sterile conditions seldom results in serious infection.
Bleeding: Continued bleeding may require reopening of the eyelid wound and either cauterization of the bleeding vessel and/or evacuation of the clot. The most common sites of bleeding are from the fat pockets and the orbicularis muscle.
Wound separation: The edges of the skin closure may separate, especially in the first day or two after suture removal. A small separation may close spontaneously or with the help of supporting tape. A larger separation may require suturing.
Suture cysts: Tiny white cysts may develop in the suture line. While most disappear without treatment, removal of a resistant cyst is simple and quick.
Asymmetry: Eyelids that look good individually may not match as a pair. Asymmetries can involve the height and shape of the upper eyelid crease, excursion of the lower eyelid margin, residual skin or fat, and so on.
Insufficient skin removal: While blepharoplasty undercorrection is always preferable to overcorrection, an objectionable amount of undercorrection may call for a "touch-up" operation.
Excessive skin removal: Excessive removal of upper eyelid skin may interfere with proper closure of the eyelids ("lagophthalmos") during blinking or especially when sleeping. Extreme shortage may distort the eyelid margin and create a widening of the palpebral fissure (opening between the eyelids) that is both cosmetically and functionally objectionable ("eyelid retraction"). Excessive removal of lower eyelid skin may cause the eyelid margin to pull away from the eye surface ("ectropion"). When mild, the main symptom may be overflow tearing due to the pulling away of the tear drain opening from the surface of the eye ("punctal eversion"). If more severe, the entire lid may be pulled downward.
Insufficient fat removal: When insufficient fat removal creates a noticeable or asymmetric blemish, further removal may be indicated.
Excessive fat removal: Excessive fat removal from the upper eyelid may create a lid crease that appears too high and deep. While fat transplantation may be attempted, long-term improvement is generally modest. Excessive fat removal in the lower eyelids may create a hollowed-out appearance.
Excessive internal scarring: Internal scarring or shrinkage of the internal eyelid layers below the skin may cause distortion, limitation of movement, and retraction. Massage may help in mild cases, but surgery may be needed to improve appearance and function.
Excessive external scarring: Scarring may be aggravated by poor or delayed healing in damaged or sensitive skin, improper placement of incisions, leaving sutures in too long, delayed healing after laser incisions, insufficient postoperative wound care, and other factors.
Rounding at the lateral commissure: Rounding of the acute angle where the outer upper and eyelids come together may be caused by excess skin and/or muscle resection or a result of canthoplasty/canthopexy. If subtle, the deformity is best ignored; if more noticeable, surgical revision may be undertaken.
Drooping upper eyelid: Blepharoplasty may "unveil" a pre-existing but unrecognized drooping upper eyelid, a condition known as "ptosis". Less commonly, injury to the levator muscle and tendon may cause ptosis to appear in a previously healthy levator system. Mild ptosis after blepharoplasty is not rare and may persist for several weeks to months. If the condition does not resolve, exploratory surgery may be indicated.
Swelling of the eyeball surface: Temporary collection of inflammatory fluid under the conjunctiva lining the eye is not uncommon. If chemosis is associated with other structural complications such as insufficient closure of the eyelids or eyelid retraction, correction of those deficiencies may be necessary.
Injury to the lacrimal system: If the main tear-producing gland is injured, prolonged swelling in the outer portion of upper eyelid may persist for several weeks. No additional surgery is required. Injury to the drainage canal is rare but requires immediate repair by an ophthalmologist.
Double vision: If the muscles that move the eyeball are injured, temporary or permanent double vision may result. The most vulnerable muscle is the "inferior oblique muscle," which courses within the fat of the lower eyelid.
Loss of vision: Mild reduction of vision following blepharoplasty is fairly common and is usually due to swelling, tearing and mucus production, and/or secondary to ointments or drops used after surgery. Catastrophic loss of vision (that is, permanent blindness) occurs infrequently (less than 1 in 10,000 cases) and is most often associated with brisk bleeding that makes its way to the area in back of the eyeball and generates enough pressure inside of the socket to cut off the normal blood flow to the retina (although the exact mechanism is not fully understood). Other possible causes of vision loss include damage to the optic nerve, needle penetration of the eyeball, and advanced eye or orbital infection. Most deep orbital hemorrhage occurs within 48 hours of surgery and is not at all subtle, usually associated with intense pain, double vision, and a sudden bulging forward of the eye. In most cases, emergency surgery by an ophthalmologist is necessary.
Complications of anesthesia: Complications may occur from the anesthesia alone, including allergic reactions, blood pressure fluctuations, and serious heart and breathing difficulties. Such problems are more common with the administration of intravenous and/or inhaled anesthetic agents than with local anesthesia.
Unrealistic expectations: If expectations are inappropriate or inflated for any operation, no matter how "perfect" the result may be from an objective point of view, the patient may not be satisfied.
Poor aesthetic choice: Not often mentioned in lists of blepharoplasty "complications" is the matter of inappropriate selection of procedure or poor aesthetic judgment on the part of the surgeon resulting in "technical" success but cosmetic "failure". For instance, if what you really need is an upper eyelid blepharoplasty but what you have done instead is a forehead lift, even though you may not experience any true medical "complication", you may still be very unhappy about the way you look. As with unrealistic expectations noted above, the best approach is avoidance.
Late complications: Most problems from surgery are apparent in the immediate post-operative period, but there are two notable exceptions:
