In eyelid surgery, a difference of a few millimeters can change both appearance and function considerably. Preventing complications requires pre-operative assessment, precise planning, conservative tissue removal and skilled surgical technique.
1. Main complications after upper blepharoplasty
Removing too much skin and fat can make the eyes look excessively large or cause lagophthalmos (incomplete eyelid closure), leading to dryness and corneal exposure. Conversely, removing too much fat can hollow the area under the brow bone and look older.
2. Main complications after lower blepharoplasty
Removing too much skin or having insufficient support can cause the lower eyelid to droop, producing scleral show or ectropion. Malposition of the eyelid stems not only from over-excision but from several factors together, including scar contracture and weak support at the outer canthus.
Rarely, a hematoma or bleeding behind the eye (retrobulbar hemorrhage) can occur; if it comes with reduced vision and severe pain, emergency evaluation is required.
3. What to check before surgery to prevent complications
The snap-back test assesses the elasticity and support of the lower eyelid, and the degree of eye protrusion, canthal ligament support and any pre-existing dry eye should be checked as well.
4. Three essentials for safe surgery
- Accurate patient assessment (distinguishing whether the cause is skin, fat, muscle or support)
- Precise surgical planning
- Conservative, skilled surgery (what is lacking can be added later, but over-excision is hard to reverse)
5. How to tell normal recovery from a complication
Swelling and tightness can cause temporary changes, but symptoms such as difficulty closing the eye completely, the lower eyelid pulling away from the eyeball, or a sudden drop in vision should be seen immediately rather than waited out.
A natural result is not an eye without a single wrinkle but an eye that opens and closes comfortably while the tired, drooping impression is improved.