--- title: "Risks and Complications of Blepharoplasty Surgery: What Patients Should Know" url: https://drturner.com.au/blogs/risks-and-complications-of-blepharoplasty-surgery-what-patients-should-know/ date: 2025-05-14 modified: 2026-07-29 author: "Dr Scott J Turner" description: "Dr Scott J Turner | Specialist Plastic Surgeon (FRACS) Key Takeaways Most early post-operative experiences are normal recovery, not complications. Swelling, bruising, tightness and temporary numbness are expected. Dry eye..." categories: - "Blepharoplasty" image: https://drturner.com.au/wp-content/uploads/2024/04/blogplaceholder-img.svg word_count: 2500 --- # Risks and Complications of Blepharoplasty Surgery: What Patients Should Know [Dr Scott J Turner](https://drturner.com.au/dr-scott-turner-sydney-plastic-surgeon/) | Specialist Plastic Surgeon (FRACS) ## Key Takeaways - **Most early post-operative experiences are normal recovery, not complications.** Swelling, bruising, tightness and temporary numbness are expected. - **Dry eye is the most common genuine complication**, particularly after combined upper and lower surgery. Most cases resolve with conservative management. - **Retrobulbar haemorrhage is rare but is the main cause of vision loss** after eyelid surgery, and it is a surgical emergency. - **Any vision change after eyelid surgery warrants urgent assessment**, not a wait-and-see approach. - **Lower eyelid surgery carries malposition risks** — retraction, ectropion, scleral show — that upper eyelid surgery does not. - **Revision is generally deferred six to twelve months**, except for urgent functional problems. Every surgical procedure carries risks. Blepharoplasty is no different. What matters is knowing the difference between a normal recovery symptom and a complication that needs attention. Swelling and bruising in the days after surgery. Tightness. Temporary numbness. All expected. Not complications. Retrobulbar haemorrhage. Persistent eyelid malposition. Unexpected vision changes. These are different — events that may need closer monitoring, medication, delayed recovery, or further treatment. This article walks through both, covering [upper blepharoplasty](https://drturner.com.au/procedures/eyes/upper-blepharoplasty/), [lower blepharoplasty](https://drturner.com.au/procedures/eyes/lower-blepharoplasty/), [male blepharoplasty](https://drturner.com.au/procedures/male/blepharoplasty/) and combined surgery. Consultations are held in Sydney and at the [Brisbane clinic](https://drturner.com.au/locations/brisbane/blepharoplasty/). This is general information, not a substitute for your own consultation and consent process. **Individual results vary**, and individual risk depends on anatomy, technique and patient factors. ## Urgent Warning Signs After Eyelid Surgery **Contact the practice urgently or seek urgent medical care if you experience any of the following:** - Sudden or significant vision changes - Severe new eye pain, particularly if escalating - Rapidly increasing one-sided swelling - Bleeding from the incision sites that doesn't settle with gentle pressure - Bulging or protrusion of the eye - Spreading redness, warmth, or pus around incisions - Wound opening - Fever - Shortness of breath, chest pain, or unusual heart rhythm These can indicate a developing complication needing same-day or emergency assessment rather than waiting for the next scheduled review. Severe new eye pain, bleeding and vision changes specifically warrant immediate medical attention. ## Expected Recovery Symptoms vs Complications Most early post-operative experiences are normal recovery. The table below separates the two. | Expected recovery symptom | When it may need review | | ------------------------- | ----------------------- | | Bruising and swelling | Sudden one-sided swelling or worsening pain | | Mild blurred vision from ointment | New or persistent vision changes | | Watery or dry eyes early on | Severe dryness, eye pain, or inability to close eyes | | Tightness or numbness | Worsening asymmetry, weakness, or new functional concern | | Mild incision redness | Spreading redness, warmth, pus, or fever | | Mild discomfort | Increasing rather than decreasing pain after 48 hours | Practical guidance on managing expected recovery, including swelling management and return-to-activity timing, is in the [blepharoplasty recovery guide](https://drturner.com.au/blogs/recovery-after-blepharoplasty/). ## Why Risks Differ by Procedure Type ### Upper blepharoplasty Upper eyelid surgery involves an incision along the natural eyelid crease, removal or repositioning of excess skin, and sometimes small amounts of muscle or fat adjustment. Specific risks include: - Dry eye, often exacerbated by reduced blink mechanics during early recovery - Lagophthalmos (incomplete eyelid closure), usually temporary - Asymmetry between the two sides, particularly during the swelling phase - Visible or asymmetric scarring at the crease incision - Over-resection of skin or fat, producing a hollowed appearance - Missed brow ptosis, which can leave residual heaviness even after well-executed eyelid surgery The brow assessment matters more than many patients realise. If the actual problem is brow descent rather than eyelid skin excess, upper blepharoplasty alone may not resolve the heaviness, and aggressive skin removal in that scenario can produce a worse result. This is covered in [how to fix hooded upper eyelids](https://drturner.com.au/blogs/how-to-fix-hooded-upper-eyelids/). ### Lower blepharoplasty Lower eyelid surgery uses one of two main approaches, with different risk profiles. **Transconjunctival approach** (incision inside the lower lid) may preserve orbicularis muscle support and the orbital septum. Current literature suggests this approach may be associated with lower rates of lower-lid retraction or ectropion in selected patients compared with transcutaneous approaches. **Transcutaneous approach** (incision just below the lash line) provides access for both fat management and excess skin excision, and may be required where significant skin laxity is present. Lower blepharoplasty risks include lower-lid retraction, ectropion, scleral show, chemosis, dry eye, hollowing from excessive fat removal, and contour irregularity. Technique selection is covered in [transconjunctival vs transcutaneous lower blepharoplasty](https://drturner.com.au/blogs/transconjunctival-vs-transcutaneous-lower-blepharoplasty-which-technique-is-right-for-you/). ## Dry Eye After Blepharoplasty Dry eye deserves a section of its own because it is among the most common complaints after periorbital surgery. Symptoms range from mild irritation to genuinely uncomfortable persistent dryness. **Symptoms** can include grittiness, watering (paradoxically, dry eye often causes reflex watering), burning, increased sensitivity to screens or wind, and a foreign-body sensation. **Risk factors** increasing the likelihood of post-operative dry eye: - Pre-existing dry eye disease, often undiagnosed before surgery - Contact lens wear - Thyroid eye disease - Lower-lid laxity - Combined upper and lower blepharoplasty rather than either alone - Excessive skin removal - Female sex and older age, both associated with higher baseline dry eye rates **What the evidence suggests.** A retrospective review of 202 patients found dry eye symptoms persisting beyond two weeks in 10.9% of patients, and beyond two months in 2%. Most cases resolved with conservative management, including artificial tears, ointment, taping the eyelids closed at night, and sometimes topical or systemic anti-inflammatory treatment. **Management** typically progresses through preservative-free artificial tears during the day, ointment at night, eyelid taping or moisture chambers in selected cases, review at the practice if symptoms persist, and ophthalmology or oculoplastic input for severe or refractory cases. A history of dry eye should be screened at consultation. It is not a contraindication in most cases, but it affects the surgical plan and post-operative monitoring. ## Chemosis Chemosis is swelling of the conjunctiva, the thin clear membrane covering the white of the eye. It can look like a swollen, jelly-like ring around the cornea, with irritation, watering, foreign-body sensation and visible swelling of the eye surface. Most cases settle with conservative management — lubrication, sometimes topical anti-inflammatory treatment, and time. Persistent or severe chemosis warrants review, and it is associated with symptomatic dry eye in the same periorbital surgery literature, which is why the two are discussed together. ## Bleeding, Haematoma and Retrobulbar Haemorrhage Bruising after blepharoplasty is expected. A haematoma — a collection of blood — is different. **Pre-septal haematoma** affects eyelid tissue in front of the orbital septum, usually appearing as more substantial swelling than expected, sometimes tense or bluish. Most are managed conservatively with cold compresses, head elevation and monitoring. **Retrobulbar haemorrhage** is rare but serious. Bleeding occurs behind the eye within the bony orbit, creating pressure on the optic nerve and surrounding structures. It is the main cause of vision loss after blepharoplasty. Signs include sudden severe pain, rapid increasing one-sided swelling that is often tense and firm, bulging or protrusion of the eye, vision changes including blurring or visual field loss, and pain on eye movement. This is a surgical emergency. Case literature stresses that decompression — lateral canthotomy and cantholysis — may need to happen urgently to preserve vision, sometimes within an hour or two of symptom onset, regardless of whether intraocular pressure measurements are abnormal at presentation. Visual change after eyelid surgery is always a reason to seek urgent assessment. ## Infection and Wound Problems Infection after blepharoplasty is uncommon, partly because the periorbital region has an excellent blood supply supporting healing. Where it occurs, signs include redness spreading beyond the immediate incision area, warmth, swelling worsening rather than settling after the first few days, discharge particularly if pus-like, and fever. Superficial infections may respond to topical or oral antibiotics; deeper infections need more urgent assessment. Wound dehiscence can occur, particularly after physical strain or rubbing. Avoiding contact lens wear, eye make-up and eye rubbing during early recovery reduces the risk. ## Eyelid Malposition: Ectropion, Retraction and Scleral Show Three related but distinct lower-lid problems: - **Ectropion** — the lower lid turns outward, exposing the inner conjunctival surface - **Retraction** — the lower lid sits lower than intended, exposing more eye than normal - **Scleral show** — more white of the eye visible below the iris than is typical Symptoms include dryness, tearing, irritation, visible asymmetry and incomplete eyelid closure. **Risk factors** include lower-lid laxity (assessed at consultation with snap-back and distraction tests), prominent eyes where the globe protrudes more anteriorly than the cheek, negative vector orbit, excessive skin removal at lower blepharoplasty, scarring from prior eyelid surgery, and previous facial nerve weakness. Mild cases may respond to massage, taping or time. More significant or persistent malposition may need revision surgery to lift or support the lower lid. Conservative surgical planning and accurate pre-operative assessment of lower-lid laxity are the main preventive factors. ## Lagophthalmos and Corneal Exposure Lagophthalmos is the inability to fully close the eyelids. Some degree during the first week is common because of swelling. Persistent lagophthalmos after swelling has settled is a different problem. The clinical consequence is corneal exposure — the cornea is not fully protected during blinking or sleep, leading to dryness, irritation and potentially corneal damage if left unmanaged. Management options include lubricating drops during the day, ointment overnight, eyelid taping at night in selected cases, review with the surgical team, ophthalmology or oculoplastic input for persistent or severe cases, and surgical correction in some cases. Conservative skin removal at upper blepharoplasty is the main preventive factor. Over-resection in pursuit of a more dramatic result can leave a patient unable to close the eye properly. ## Scarring and Skin Changes Eyelid skin generally heals well. Most blepharoplasty scars become inconspicuous within the natural eyelid crease, or just below the lash line for transcutaneous lower surgery. Transconjunctival lower blepharoplasty leaves no external scar. Scar issues that can still occur include visible scarring outside the natural crease, pigmentation changes lighter or darker than surrounding skin, hypertrophic or thickened scarring (uncommon in this area but possible), and asymmetric scar appearance between the two sides. Scar maturation typically takes six to twelve months. Sun protection during this period helps reduce hyperpigmentation. Silicone gel or sheets may be discussed once incisions are fully sealed and cleared. Do not apply scar products to unhealed incisions. ## Aesthetic Concerns and Revision Surgery Aesthetic outcomes can be unsatisfactory even where the technical surgery has gone well. Concerns include hollowing of the upper or lower eyelid from over-resection of fat, residual under-eye bags or upper-lid skin from under-correction, asymmetry between the two sides, crease height that doesn't match expectations, contour irregularity at incision ends, and lower-lid shape change. Revision decisions are usually deferred until swelling has fully settled and scars have matured — typically at least six to twelve months. Acting earlier risks operating on tissue that is still changing, which can produce a worse rather than better outcome. The exception is urgent functional problems such as significant lagophthalmos or ectropion, which need earlier intervention. ## Anaesthesia and General Surgical Risks Beyond eyelid-specific risks, blepharoplasty carries the general risks of any surgical procedure under anaesthesia: anaesthetic reaction, post-operative nausea, blood clots including deep vein thrombosis (rare for procedures of this length but part of general surgical risk), and medical complications related to existing health conditions. The anaesthetic risk discussion happens with the anaesthetist before surgery. Full disclosure of all medications, allergies, previous anaesthetic experiences and medical history is critical. ## Who May Be at Higher Risk Some patients have a higher baseline risk. The main ones: pre-existing dry eye disease; thyroid eye disease; prominent eyes; negative vector orbit; lower-lid laxity; previous eyelid or facial surgery; facial nerve palsy; diabetes or autoimmune disease; current smoking or nicotine use; blood-thinning medication; and unrealistic expectations about what surgery can achieve. None of these necessarily rules out surgery. They do affect the surgical plan, pre-operative assessment and the discussion of realistic outcomes. Candidacy is covered in [how to qualify for eyelid surgery in Australia](https://drturner.com.au/blogs/qualify-for-eyelid-surgery-australia/). ## Medication and Supplement Management Tell the surgical team and the anaesthetist about every prescription medication, over-the-counter product and supplement you take. This is genuinely important rather than a formality. - **Do not stop prescribed anticoagulants** — warfarin, apixaban, rivaroxaban, dabigatran, clopidogrel — without advice from both the prescribing doctor and the surgical team. Sudden discontinuation carries its own risks. - **Aspirin, NSAIDs, fish oil, high-dose vitamin E and certain herbal supplements** including ginkgo, garlic and ginseng can affect bleeding risk in some patients. - **Medication instructions are individualised.** Follow the specific plan provided by your surgical and prescribing doctors rather than generic advice. ## Post-Operative Care to Reduce Complications Specific instructions come with surgery. The general principles: cold compresses as instructed, wrapped rather than on bare skin; head elevation through the first week; no bending, straining, heavy lifting or vigorous exercise; no rubbing the eyes; no contact lenses or eye make-up until cleared; prescribed drops and ointments as directed; and attendance at all follow-up appointments. Detailed recovery timing, including swelling management and a return-to-activity table, is in the [blepharoplasty recovery guide](https://drturner.com.au/blogs/recovery-after-blepharoplasty/). ## Frequently Asked Questions **What are the most common risks of blepharoplasty?** The most common issues are temporary recovery symptoms — bruising, swelling, watering, mild blurred vision from ointment, temporary numbness — rather than true complications. Among actual complications, dry eye is the most common, particularly after combined upper and lower surgery. Others include chemosis, asymmetry during healing, lower-lid malposition in lower blepharoplasty cases, and aesthetic concerns such as hollowing or under-correction. Serious complications including retrobulbar haemorrhage and vision loss are rare but documented. **Is dry eye common after blepharoplasty?** Yes — it is among the most common complaints after periorbital surgery. A retrospective review of 202 patients found symptoms persisting beyond two weeks in around 11%, and beyond two months in 2%. Most resolve with conservative management including artificial tears, ointment at night and sometimes eyelid taping. **Can blepharoplasty affect vision?** Vision changes are uncommon but possible. Temporary blurring from ointment or swelling is normal early and settles within days. Persistent or progressive vision changes are not normal and require urgent assessment. The most serious vision-threatening complication is retrobulbar haemorrhage. **What is ectropion after lower blepharoplasty?** Ectropion is when the lower eyelid turns outward, exposing the inner conjunctival surface, causing dryness, tearing, irritation and visible distortion of lid shape. Risk factors include pre-existing lower-lid laxity, prominent eyes, negative vector orbit, excessive skin removal and prior scarring. Mild cases may respond to massage or taping; more significant cases typically require revision surgery. **When should I call the practice after blepharoplasty?** Sudden vision changes, severe new eye pain, rapidly increasing one-sided swelling, bleeding that doesn't settle, fever, spreading redness or pus, or wound opening all warrant a same-day call. Most patients have an uneventful recovery, but the threshold for calling should be low. If something doesn't seem right and the practice can't be reached immediately, hospital emergency departments can assess eyelid concerns out of hours. If you're weighing up eyelid surgery and want the risks discussed against your own anatomy and medical history rather than a general list, that's what a consultation is for — and an honest risk discussion is part of it. Dr Scott Turner consults in Sydney and Brisbane. For clinic information and the consultation pathway, visit the [Sydney clinic](https://drturner.com.au/locations/sydney-clinic/) or [Brisbane clinic](https://drturner.com.au/locations/brisbane/), or [contact the practice](https://drturner.com.au/contact-us/) to arrange a consultation.