Key points
- Complications of eyelid surgery range widely, from skin changes to sight-threatening emergencies [1].
- From the patient's point of view, they can be grouped into three areas: appearance, function, and discomfort, and these can occur together [2].
- Complications of upper eyelid surgery are usually minor, but lower eyelid surgery can lead to more serious complications, such as an abnormal eyelid position [3].
- Some complications can be prevented with careful preoperative evaluation and surgical technique, and when they do occur, proper management can reduce their impact [1].
- Outer-corner support (canthal suspension) is used as a preventive measure in cases such as a lax lower eyelid, so your individual risk factors should be reviewed with a specialist [4].
How can complications be grouped?
Eyelid surgery is described as a commonly performed cosmetic operation because a relatively short procedure can make a big difference to the face, with an acceptable level of risk [3]. Even so, complications after surgery vary widely, from minor skin changes to sight-threatening emergencies [1].
The problems patients experience fall into three broad groups: appearance problems, where the shape is not what was expected; functional problems with opening and closing the eyes; and problems of discomfort and symptoms, such as pain or a feeling that something is in the eye. These can overlap [2]. How a problem is managed depends on which kind it is.
Complications by time after surgery
One review organized the main complications of eyelid surgery by when they appear after surgery [1]. Knowing the typical timeline can help you understand what changes to watch for after surgery.
- First week: scratches on the cornea (corneal abrasion) and bleeding behind the eye that can threaten vision (retrobulbar hemorrhage)
- Weeks 1 to 6: an abnormal position of the upper or lower eyelid, misaligned eyes (strabismus), exposure of the cornea, and watery eyes
- After 6 weeks: changes in eyelid height and contour, asymmetry, scarring, and long-lasting swelling
How the risks differ between upper and lower eyelid surgery
Complications of upper eyelid surgery are described as usually minor, especially when skin is removed conservatively and volume is preserved [3]. Careful fat removal is emphasized so that the upper eyelid does not become hollow, and adding volume with a fat graft or filler may also be considered when needed [3].
Lower eyelid surgery, on the other hand, can lead to more serious complications, including an abnormal eyelid position (lid malposition), so a very careful approach is stressed [3]. This is because the lower eyelid is a delicate area where even small adjustments can greatly change its shape [4].
Prevention starts with the preoperative evaluation
Some complications are described as preventable with careful preoperative evaluation and surgical technique [1]. Eyelid surgery has recently shifted toward preserving, and sometimes adding, volume in both the upper and lower eyelids, and a stepwise approach tailored to each person's findings has been described as a way to make results more predictable [3].
In lower eyelid surgery, outer-corner support (canthal suspension) is useful for preventing complications. It is described as especially important when the lower eyelid is very lax, when the eyes are relatively prominent, or when the cheek sits behind the eyeball (a negative vector) [4]. The most conservative option is canthopexy, and lateral canthoplasty is considered when laxity is marked [4].
If you are also planning brow or forehead surgery, you should separately check the complications of that surgery and how to reduce them [5].
If a complication occurs
Even when a complication occurs, the literature notes that proper management can reduce its impact [1]. Management includes both medical treatment, such as medication, and surgical correction, and the approach depends on the type of problem and when it appears [2].
Complications that can threaten vision, such as bleeding behind the eye, can appear in the first week after surgery [1], so if you have pain that suddenly gets worse or any change in your vision, contact your medical team without delay. Changes that evolve over time, such as swelling or asymmetry, are best assessed by following their course together with your surgeon.
What to ask during your consultation
The risk of complications varies from person to person depending on eyelid structure, skin condition, and the extent of surgery. Checking the points below before surgery can help you understand the risks and be prepared [1].
- Your individual risk factors, such as a lax lower eyelid or prominent eyes
- How much skin and fat will be removed, and whether the plan preserves volume
- Whether outer-corner support (canthal suspension) is needed
- Symptoms to watch for at each stage and how to reach the clinic in an emergency
- How complications would be managed if they occur, and the possibility of revision surgery
Frequently asked questions
- Are complications of eyelid surgery common?
- The research summaries used for this article did not give figures for complication rates. Complications of upper eyelid surgery are described as usually minor, but it is stressed that lower eyelid surgery can lead to more serious complications [3]. It is best to have your individual risk checked through an examination.
- Why does lower eyelid surgery call for extra caution?
- Lower eyelid surgery can lead to serious complications such as an abnormal eyelid position [3], and it is an area where even small adjustments can greatly change the shape [4]. For this reason, preventive measures such as outer-corner support (canthal suspension) are also considered in cases such as a lax eyelid [4].
- Can eyelid surgery cause problems with my vision?
- Bleeding behind the eye, which can appear in the first week after surgery, is listed as a complication that can threaten vision [1]. Problems involving the surface of the eye, such as corneal abrasion and corneal exposure, have also been reported, so if you notice a change in your vision or severe pain after surgery, seek care right away [1].
References
- Lelli GJ Jr, Lisman RD. Blepharoplasty complications. Plast Reconstr Surg. 2010.PubMed 20195127DOI
- Mack WP. Blepharoplasty complications. Facial Plast Surg. 2012.PubMed 22723228DOI
- Zoumalan CI, Roostaeian J. Simplifying Blepharoplasty. Plast Reconstr Surg. 2016.PubMed 26710052DOI
- De Silva DJ, Prasad A. Aesthetic canthal suspension. Clin Plast Surg. 2015.PubMed 25440744DOI
- Lee H, Quatela VC. Endoscopic Browplasty. Facial Plast Surg. 2018.PubMed 29631282DOI
This article is an English translation of general health information that DOY JUN Plastic Surgery compiled in Korean from the summaries (abstracts) of papers in international academic journals. Treatment methods and results vary depending on each person's condition, so please consult a specialist for an accurate diagnosis and treatment plan.
