Understanding the Risks and Complications of Blepharoplasty Surgery

Blepharoplasty, commonly known as eyelid surgery, is among the most frequently performed facial aesthetic procedures in Australia. Whether addressing concerns with the upper eyelids, lower eyelids, or both, this surgical approach can effectively treat excess skin, protruding fat deposits, and tissue redundancy that contribute to an aged or fatigued appearance around the eyes. For some patients, upper blepharoplasty also serves a functional purpose by removing tissue that obstructs peripheral vision.

At FacePlus Aesthetics, Dr Scott J Turner, Specialist Plastic Surgeon (FRACS), maintains a strong commitment to patient education. Every individual considering eyelid surgery deserves comprehensive information about both the expected outcomes and the potential risks involved. This detailed guide outlines the complications that may arise following blepharoplasty, how they are managed, and the measures employed to reduce their likelihood.

Different Blepharoplasty Approaches and Their Risk Profiles

The surgical approach selected for blepharoplasty influences both the recovery experience and the specific risks involved. Understanding these distinctions helps patients appreciate why certain techniques may be recommended for their particular anatomy and concerns.

Upper Blepharoplasty

Upper eyelid surgery involves an incision placed within the natural eyelid crease, through which excess skin, muscle, and, when necessary, protruding fat pads are addressed. This incision placement typically results in well-concealed scarring that becomes barely perceptible once fully healed. The procedure may be performed under local anaesthesia with sedation or general anaesthesia, depending on individual circumstances and the surgeon’s recommendation.

Lower Blepharoplasty

Lower eyelid surgery can be accomplished through two primary approaches, each carrying distinct risk considerations. The transcutaneous (subciliary) approach places the incision just beneath the eyelash line, providing access to address excess skin whilst also managing fat deposits. The transconjunctival approach positions the incision on the inner surface of the lower eyelid, leaving no externally visible scar. This latter technique is often favoured for patients whose primary concern involves prominent fat pads without significant skin excess, as it carries a notably lower incidence of eyelid position changes following surgery.

Expected Post-Operative Effects

Certain effects following blepharoplasty represent normal aspects of the healing process rather than true complications. Recognising these anticipated responses helps patients distinguish between expected recovery experiences and symptoms warranting medical attention.

Swelling and bruising around the eyelids typically reach their peak between 48 and 72 hours following surgery, then gradually diminish over the subsequent 7 to 14 days. Temporary blurred vision may occur, particularly in the immediate post-operative period when antibiotic ointment is applied to the incision sites. Light sensitivity and watery eyes are common during initial recovery and resolve as healing progresses.

Altered sensation around the eyelids, including numbness or tingling, represents a normal healing response. Most patients experience restoration of normal sensation within 2 to 4 months, though this timeline varies among individuals. Mild discomfort rather than significant pain characterises the typical recovery experience, readily managed with simple pain relief medication as directed.

Moderate Complications Requiring Attention

Conjunctival Swelling (Chemosis)

Chemosis describes swelling of the conjunctiva, the transparent membrane covering the white portion of the eye. When this occurs, patients may experience a gritty sensation, increased eye irritation, and visible redness. Though uncomfortable, chemosis typically resolves with conservative management, including lubricating eye drops and time. The condition occurs in a small proportion of blepharoplasty patients and does not usually indicate a serious problem.

Blood Collection (Haematoma)

Haematomas represent collections of blood within the surgical site. Pre-septal haematomas, confined to the eyelid tissue itself, generally respond well to conservative measures such as cold compresses and typically resolve without intervention. Post-septal or retrobulbar haematomas, occurring behind the orbital septum, constitute more serious complications requiring prompt assessment and potentially urgent treatment. The incidence of significant haematoma formation remains low when surgery is performed with meticulous attention to bleeding control throughout the procedure.

Changes in Lower Eyelid Position

Lower eyelid malposition encompasses conditions including retraction (where the eyelid sits lower than desired) and ectropion (outward turning of the eyelid margin). These complications affect both function and appearance, potentially causing eye exposure symptoms and cosmetic concerns. The risk varies considerably by surgical approach, with transconjunctival techniques demonstrating substantially lower malposition rates than transcutaneous approaches. Patient anatomy also influences risk, particularly in individuals with prominent eyes or relatively flat cheekbones.

Serious Complications

Whilst serious complications following blepharoplasty remain uncommon, patients must understand these possibilities before proceeding with surgery. Knowledge of warning signs enables timely intervention when necessary.

Visual Changes

Vision impairment represents the most significant potential complication of eyelid surgery, though it occurs very rarely. Retrobulbar haemorrhage, a collection of blood behind the eye causing increased orbital pressure, constitutes the primary mechanism through which vision may be affected. When visual changes develop, they typically manifest within the first 24 hours following surgery. Immediate intervention is critical in such circumstances, with treatment ideally initiated within 1 to 2 hours of symptom onset to preserve visual function.

Incomplete Eyelid Closure (Lagophthalmos)

Lagophthalmos describes the inability to fully close the eyelids, which may result from excessive tissue removal during surgery. Transient difficulty with eyelid closure commonly occurs during the first week due to post-operative swelling and typically resolves spontaneously. Persistent lagophthalmos, however, leads to corneal exposure with associated dryness, irritation, and potential damage to the corneal surface. Management ranges from aggressive lubrication to surgical correction, depending on severity and duration.

Wound Infection

Infection following blepharoplasty occurs infrequently, owing mainly to the excellent blood supply of the periorbital tissues, which supports robust immune function and healing capacity. When infections do develop, they range from superficial wound involvement to more extensive cellulitis. Strict adherence to sterile surgical technique and diligent wound care during recovery minimises infection risk. Signs of infection include increasing pain, spreading redness, warmth, and discharge from incision sites.

Aesthetic and Sensory Concerns

Asymmetry

Some degree of asymmetry between the two sides is present in virtually all faces, and this natural variation may persist or become more apparent after surgery. Temporary differences during the healing period often relate to uneven swelling and typically equalise as recovery progresses. Significant persistent asymmetry beyond the expected healing timeframe may warrant consideration of revision surgery to improve the balance between the eyelids.

Unsatisfactory Aesthetic Outcomes

Potential aesthetic concerns following blepharoplasty include a hollowed appearance from excessive fat removal, residual puffiness from undercorrection, visible or poorly positioned scars, and contour irregularities at incision endpoints. Conservative surgical technique, avoiding over-resection of tissues, helps prevent the hollow appearance that proves challenging to correct. The final appearance of scars continues to mature over many months, with most achieving excellent camouflage within the natural eyelid structures by twelve months post-operatively.

Dry Eye Symptoms

Dry eye symptoms occur relatively commonly following blepharoplasty, with reported rates approaching one quarter of patients to some degree. The likelihood increases when upper and lower eyelid procedures are performed simultaneously. For most individuals, these symptoms prove temporary and resolve within approximately eight weeks as normal tear film dynamics re-establish. Management varies according to severity, ranging from preservative-free artificial tears for mild cases to ophthalmic gels and additional interventions for more pronounced symptoms.

Reducing Your Risk of Complications

Pre-Operative Considerations

A comprehensive preoperative assessment identifies factors that may influence surgical risk. This evaluation encompasses medical history review, current medication assessment, screening for pre-existing eye conditions, and anatomical evaluation of eyelid structure and support. Patients with certain medical conditions, thyroid disorders, uncontrolled hypertension, or pre-existing dry eye syndrome require particular attention during planning to optimise safety and outcomes.

Medication Adjustments

Certain medications and supplements significantly increase bleeding risk during and after surgery. Blood-thinning medications, non-steroidal anti-inflammatory drugs, vitamin E supplements, fish oil, and various herbal preparations are typically discontinued before surgery. Specific guidance regarding which medications to cease and the appropriate timeframe should be discussed with your surgeon and, where relevant, the prescribing physician of any essential medications.

Smoking Cessation

Tobacco use impairs wound healing, increases infection risk, and compromises the body’s capacity to recover from surgery. Patients are strongly advised to cease smoking for a minimum of four to six weeks before and after blepharoplasty. This recommendation extends to all forms of nicotine delivery, including vaping and nicotine replacement products, during the critical healing period.

Post-Operative Care

Appropriate care following surgery supports optimal healing and reduces the risk of complications. Key measures include applying cold compresses during the first 48 hours, maintaining head elevation, particularly during sleep, avoiding activities that increase eye or blood pressure, such as bending, straining, and heavy lifting for at least one week, using prescribed eye ointments and drops as directed, refraining from rubbing the eyes, and attending all scheduled follow-up appointments to monitor healing progress.

Warning Signs Requiring Immediate Attention

Certain symptoms following blepharoplasty warrant urgent medical assessment. Contact Dr Turner’s clinic or seek immediate medical care if you experience severe, new, or worsening eye pain, sudden or significant changes in vision, bulging or protrusion of the eye, increasing redness, swelling, or discharge suggesting infection, or persistent or heavy bleeding from incision sites. Prompt evaluation of concerning symptoms enables timely intervention when needed.

The Importance of Surgeon Selection

Choosing an appropriately qualified surgeon represents one of the most significant factors in achieving safe outcomes from blepharoplasty. Dr Scott J Turner is a Specialist Plastic Surgeon holding FRACS credentials, indicating completion of extensive accredited training specifically in plastic surgery. His practice focuses on facial aesthetic surgery, bringing a focused approach to each blepharoplasty procedure.

All procedures at FacePlus Aesthetics are performed in fully accredited hospital facilities with experienced anaesthetic support. Dr Turner conducts a minimum of two personal consultations before any surgical procedure, ensuring adequate time to understand each patient’s concerns, explain the proposed approach, discuss potential risks comprehensively, and establish realistic expectations for outcomes and recovery.

Making an Informed Decision

Blepharoplasty can achieve excellent outcomes for appropriately selected patients when performed by a qualified surgeon with comprehensive pre-operative planning and diligent post-operative care. Understanding the full spectrum of potential risks, from common temporary effects to rare serious complications, enables informed decision-making about whether to proceed with surgery.

If you are considering eyelid surgery, we encourage you to schedule a consultation with Dr Turner at our Sydney or Brisbane clinic to discuss your individual circumstances, concerns, and aesthetic goals. During this appointment, all aspects of the procedure, including specific risks relevant to your anatomy and health status, can be thoroughly explored.