Upper Blepharoplasty Complications: Risks and How to Avoid Them

Table of Contents

• Understanding Upper Blepharoplasty: Procedure and Expectations
• Common Upper Blepharoplasty Complications to Be Aware Of
• Can Upper Eyelid Surgery Lead to Serious Vision Problems?
• Factors That Increase Risk of Eyelid Surgery Complications
• How to Choose a Qualified Plastic Surgeon for Blepharoplasty
• Essential Post-Operative Care to Minimize Complications
• Addressing Unsatisfactory Results: Revision Surgery Options
• Long-Term Outlook: Managing and Preventing Future Issues

Understanding Upper Blepharoplasty: Procedure and Expectations

Upper blepharoplasty is a surgical procedure designed to rejuvenate the upper eyelids by removing excess skin, muscle, and sometimes fat. As a Consultant Plastic Surgeon at The Christie Cancer Centre in Manchester, I perform this procedure to address hooding, droopiness, and the tired appearance that often develops with age.

The surgery typically takes 1-2 hours under local anaesthesia with sedation or general anaesthesia. I make precise incisions along the natural crease of the upper eyelid, carefully remove the redundant tissue, and close with fine sutures that minimise visible scarring. Most patients can expect the incision to heal within 7-10 days, with final results becoming apparent after several weeks as swelling subsides.

Realistic expectations are crucial for satisfaction with your results. Upper blepharoplasty can dramatically refresh your appearance and potentially improve peripheral vision if excess skin was obstructing it. However, it cannot eliminate crow’s feet, lift sagging eyebrows, or address dark circles. During your consultation, I thoroughly discuss what the procedure can and cannot achieve to ensure your expectations align with realistic outcomes.

Common Upper Blepharoplasty Complications to Be Aware Of

While upper blepharoplasty is generally safe, as with any surgical procedure, complications can occur. Understanding these potential issues is essential for informed consent and appropriate post-operative vigilance.

Temporary complications include bruising, swelling, and discomfort, which typically resolve within 1-3 weeks. Dry eyes are also common initially, as swelling can affect the normal blinking mechanism and tear distribution. More persistent complications might include:

• Asymmetry: Minor asymmetries are normal and often resolve with healing, but significant differences may require revision.
• Scarring: While incisions are placed in the natural eyelid crease, some patients may develop hypertrophic or visible scarring.
• Lagophthalmos: Inability to close the eyes completely, which may be temporary during healing or persistent if too much skin is removed.
• Ptosis: Drooping of the upper eyelid due to injury to the levator muscle during surgery.
• Hollowness: Excessive fat removal can create a sunken appearance.

These complications occur in a small percentage of cases but underline the importance of selecting a surgeon with specific expertise in periorbital anatomy and surgical technique. Similar to breast augmentation risks, proper planning and surgical judgement significantly reduce these complications.

Can Upper Eyelid Surgery Lead to Serious Vision Problems?

One of the most concerning questions patients ask is whether blepharoplasty can affect their vision. The answer requires nuance. While serious vision complications are rare, they are possible and warrant discussion.

The most severe potential complication is retrobulbar haematoma—bleeding behind the eye that can compress the optic nerve and, if not promptly treated, lead to permanent vision loss or even blindness. This emergency presents with severe pain, decreased vision, and increased pressure in the eye, requiring immediate surgical intervention. Fortunately, with proper technique and post-operative monitoring, this complication occurs in less than 0.1% of cases.

More common vision-related issues include:

• Corneal exposure: If too much skin is removed, the eyes may not close properly, leading to corneal dryness and potential damage.
• Double vision (diplopia): Temporary double vision can occur due to swelling or injury to the extraocular muscles.
• Chemosis: Conjunctival swelling that can blur vision temporarily.

As a Consultant at The Christie, patient safety is my paramount concern. I implement specific protocols to minimise these risks, including meticulous pre-operative assessment, conservative tissue removal, and detailed post-operative instructions with clear warning signs requiring immediate attention.

Factors That Increase Risk of Eyelid Surgery Complications

Certain patient factors can significantly increase the risk of complications during and after upper blepharoplasty. Identifying these risk factors allows for personalised pre-operative planning and post-operative care.

Medical conditions that increase complication risk include:

• Dry eye syndrome: Pre-existing dry eyes may worsen after surgery.
• Thyroid disorders: Particularly Graves’ disease, which affects periorbital tissues and healing.
• Hypertension: Increases bleeding risk and can lead to haematoma formation.
• Diabetes: Compromises wound healing and increases infection susceptibility.
• Cardiovascular disease: May affect anaesthesia choices and healing capacity.

Medications and supplements that increase bleeding risk include aspirin, NSAIDs, vitamin E, fish oil, and herbal supplements like ginkgo biloba and garlic. These typically need to be discontinued 2-3 weeks before surgery.

Lifestyle factors also play a critical role. Smoking significantly impairs healing and increases complication rates by restricting blood flow to tissues. I advise patients to cease smoking at least 4 weeks before and after surgery. Alcohol consumption should be minimised as it can increase bleeding and swelling. Age itself is not necessarily a contraindication, but older patients may have thinner skin and different healing profiles requiring adjusted surgical planning.

How to Choose a Qualified Plastic Surgeon for Blepharoplasty

Selecting the right surgeon is perhaps the most important decision you’ll make regarding your blepharoplasty. The periorbital area is complex, requiring specialised knowledge of both functional and aesthetic aspects of eyelid surgery.

When choosing a surgeon, verify these essential credentials:

• Board certification: In the UK, look for FRCS(Plast) qualification and GMC Specialist Register listing in Plastic Surgery.
• Specific training: Enquire about fellowship training or specialisation in oculoplastic or facial plastic surgery.
• Hospital privileges: Surgeons with operating privileges at established hospitals have undergone rigorous credentialing.
• Experience: Ask how many blepharoplasties they perform annually and their complication rates.

Beyond credentials, evaluate before-and-after photos of previous patients with similar features to yours. These should show consistent, natural-looking results across multiple patients. During consultation, the surgeon should thoroughly discuss risks and complications specific to your case, not merely provide generic information.

Trust your instincts about communication style. Your surgeon should listen attentively to your concerns, explain options clearly, and neither pressure you into decisions nor dismiss your questions. As a Consultant at The Christie, I emphasise transparent communication and individualised care plans based on each patient’s unique anatomical features and aesthetic goals.

Essential Post-Operative Care to Minimize Complications

Proper post-operative care is crucial for minimising complications and ensuring optimal healing after upper blepharoplasty. Following your surgeon’s specific instructions is paramount, but there are several universal principles that help reduce risk.

Immediately after surgery, apply cold compresses intermittently (20 minutes on, 20 minutes off) for the first 48 hours to reduce swelling and bruising. Keep your head elevated, including while sleeping, by using 2-3 pillows for at least one week. This reduces pressure in the periorbital area and facilitates fluid drainage.

Medication management is critical. Take prescribed antibiotics completely as directed to prevent infection. Pain management typically involves paracetamol rather than NSAIDs, which can increase bleeding risk. Lubricating eye drops and ointments are essential to prevent corneal dryness, especially if you experience temporary difficulty closing your eyes fully.

Activity restrictions include:

• Avoiding bending, heavy lifting, or strenuous activity for at least 2 weeks
• No swimming for 3-4 weeks
• Refraining from contact lens use for at least 2 weeks
• Protecting your eyes from sun and wind with dark sunglasses
• Avoiding eye makeup and facial products near the incision sites for at least 2 weeks

Attend all follow-up appointments, even if you feel your recovery is progressing well. These visits allow early identification and management of potential complications before they become serious.

Addressing Unsatisfactory Results: Revision Surgery Options

Despite careful planning and execution, some patients may be dissatisfied with their upper blepharoplasty results or experience complications requiring correction. As a surgeon who specialises in both primary and revision procedures, I approach these cases with particular attention to detail and realistic expectations.

Common reasons for revision include:

• Residual excess skin: Conservative primary surgery may leave some redundant skin.
• Asymmetry: Differences in healing or pre-existing asymmetries that become more noticeable.
• Hollow upper eyelids: Excessive fat removal creating a sunken appearance.
• Visible scarring: Hypertrophic or widened scars that don’t fade as expected.
• Functional issues: Difficulty closing the eyes (lagophthalmos) or eyelid retraction.

Timing is crucial for revision surgery. I typically advise waiting at least 6-12 months after the primary procedure to allow complete healing and scar maturation. Rushing into revision can compound problems and limit options.

Revision techniques vary based on the specific issue. For residual skin, additional excision may be appropriate. For hollowness, fat grafting or dermal fillers can restore volume. Scar revision may involve excision and careful reapproximation or laser treatments. Functional issues often require more complex techniques including potential grafting procedures to restore normal eyelid mechanics.

Patients considering revision should understand that secondary surgery often has limitations and may not achieve perfection, though significant improvement is typically possible with appropriate techniques.

Long-Term Outlook: Managing and Preventing Future Issues

Upper blepharoplasty results are generally long-lasting, though not permanent. The natural ageing process continues, and tissues will experience changes over time. Understanding how to maintain your results and when additional procedures might be considered helps set realistic long-term expectations.

For most patients, upper blepharoplasty results last 7-10 years before significant skin laxity might recur. However, this varies considerably based on individual factors including genetics, sun exposure, and lifestyle choices. Some patients never require revision, while others might notice changes sooner.

To maximise the longevity of your results:

• Sun protection: Wear sunglasses and apply broad-spectrum SPF to the periorbital area daily to prevent collagen breakdown and skin laxity.
• Skincare: Use medical-grade products containing retinoids, antioxidants, and peptides to maintain skin quality.
• Avoid smoking: Smoking accelerates collagen breakdown and skin ageing.
• Maintain stable weight: Significant weight fluctuations can affect facial fat distribution and skin elasticity.

Non-surgical maintenance options include botulinum toxin injections for crow’s feet, careful use of dermal fillers for hollowness, and non-invasive skin tightening treatments. These can extend the results of your blepharoplasty without additional surgery.

If recurrent hooding occurs years later, a repeat blepharoplasty is possible. However, subsequent procedures typically remove less tissue than the initial surgery. Sometimes, brow ptosis (drooping) contributes to recurrent upper eyelid heaviness, and a brow lift might be more appropriate than revision blepharoplasty.

As your Consultant Plastic Surgeon at The Christie, I provide ongoing assessment and personalised recommendations to help maintain your refreshed appearance for years to come.