Last Updated May 2025
Eyelid surgery, or blepharoplasty, is a popular procedure for rejuvenating the appearance of the eyes and addressing age-related changes around the eyelids. This procedure aims to remove excess skin, and in some cases muscle and fat, from the upper or lower eyelids to restore a more rejuvenated and rested appearance. While blepharoplasty can provide excellent results for suitable candidates, like all surgical procedures, it carries certain risks and potential complications that patients should understand before proceeding.
At Dr Scott J Turner’s clinics in Manly and Double Bay, patient safety is paramount. This guide outlines the potential complications associated with blepharoplasty and how they are managed to ensure you can make an informed decision about your surgery.
Types of Blepharoplasty Procedures
Before discussing complications, it’s helpful to understand the different types of blepharoplasty procedures:
Upper Eyelid Blepharoplasty: Targets baggy or droopy upper eyelids, removing excess skin that may hinder peripheral vision. The incision is made along the natural fold of the upper eyelid. Learn more about upper eyelid surgery.
Lower Eyelid Blepharoplasty: Addresses excess skin and “bags” under the eyes. This can be performed using either:
- Transcutaneous (Subciliary) Approach: An incision made just below the eyelashes
- Transconjunctival Approach: An incision made on the inside of the lower eyelid, leaving no visible external scar
Learn more about lower eyelid surgery.
The transconjunctival approach is often preferred for younger patients with prominent lower eyelid fat pads but minimal excess skin, as it has a significantly lower rate of postoperative eyelid malposition compared to the transcutaneous approach.
Understanding Blepharoplasty Complication Rates
Blepharoplasty is generally considered a safe procedure with a relatively low complication rate of approximately 9.5% of cases. Most complications are mild and resolve without long-term consequences. However, it’s important to understand both common and rare risks before proceeding with surgery.
Common Temporary Side Effects
Most patients will experience some degree of expected post-operative symptoms that are a normal part of the healing process:
- Bruising and swelling around the eyelids (typically resolving within 7-10 days)
- Light sensitivity and watery eyes during the initial recovery period
- Temporary blurred vision (usually resolving within 1-2 days)
- Discomfort, tightness, or numbness of the eyelids (sensation typically returns over 2-4 months)
- Dry or irritated eyes requiring lubricating drops
- Mild inflammation at incision sites
These symptoms are considered normal aspects of recovery rather than true complications and typically resolve within 1-2 weeks as healing progresses.
Moderate Complications
Chemosis
Chemosis, or swelling of the conjunctiva (the clear membrane covering the white of the eye), occurs in a small percentage of cases. This can cause a foreign body sensation, irritation, and redness but typically resolves with conservative management.
Haematoma
Haematomas are collections of blood that can occur following surgery:
- Pre-septal haematomas: Confined to the eyelid alone, these typically resolve with conservative measures such as ice packs
- Post-septal (retrobulbar) haematomas: These are more serious complications that could potentially compromise vision if not addressed promptly. This is a rare event, with an estimated incidence of approximately 1 in 2,000 procedures (0.05%).
Eyelid Malposition
Lower eyelid malposition, including retraction and ectropion (outward turning of the eyelid), represents another category of potential complications that can cause both functional and cosmetic concerns. The risk varies significantly based on the surgical approach:
- The transcutaneous (subciliary) approach may have retraction rates up to 20% and frank ectropion in approximately 1% of cases
- The transconjunctival approach is associated with a much lower incidence of these malpositions
Serious Complications
Visual Impairment
The most severe potential complication of blepharoplasty is vision loss. While extremely rare (approximately one in 10,000 to 30,000 cases), this serious outcome deserves particular attention:
- Retrobulbar haemorrhage is the main cause of blindness following blepharoplasty
- When visual changes occur, they typically develop within the first 24 hours after surgery
- Immediate intervention is critical to preserve vision, ideally within 1-2 hours
Lagophthalmos and Corneal Exposure
Lagophthalmos, the inability to fully close the eyelids, can occur if excessive skin is removed. While mild, transient lagophthalmos is common in the first week after surgery due to swelling, persistent lagophthalmos can lead to corneal exposure, dryness, and potential damage requiring aggressive management with lubricants or, in some cases, surgical correction.
Infection
While infections are rare (approximately 0.2% of cases) due to the excellent blood supply in the periorbital region, they can range from mild superficial cellulitis to more severe conditions. Strict adherence to aseptic surgical techniques and diligent postoperative wound care are essential in minimizing infection risk.
Aesthetic and Sensory Complications
Asymmetry
Some degree of asymmetry after surgery is not uncommon, as the human face possesses natural asymmetry. Temporary differences between sides are often due to uneven swelling in the early postoperative period. However, significant asymmetry that persists beyond the healing phase may require revision surgery.
Unsatisfactory Results
Potential aesthetic issues include:
- “Hollowed look” from excessive fat removal
- Residual bags or puffiness from under-correction
- Visible or poorly positioned scars
- Contour irregularities or “dog ears” (small puckers) at incision ends
Scarring
While eyelid skin generally heals with minimal scarring and hypertrophic (raised, thickened) scars are unusual in this area, abnormal scarring can still occur. The final appearance of scars can take several months to a year to fully mature.
Prevention Strategies and Patient Screening
Pre-operative Assessment
A thorough preoperative assessment is essential to identify factors that may increase surgical risk:
- Medical history review: Identifying conditions like thyroid disease, hypertension, diabetes, or autoimmune conditions that may impact surgical outcomes
- Medication evaluation: Assessing medications that may increase bleeding risk
- Eye health assessment: Screening for pre-existing dry eye syndrome or other ocular conditions
- Anatomical assessment: Evaluating eyelid laxity, tone, and support, particularly for patients with “negative vector” orbit (where the cheekbone is relatively flat compared to the eyeball) or prominent eyes, who may be at increased risk for complications
Medication Management
Certain medications significantly increase bleeding risk and should be discontinued prior to surgery (with your doctor’s approval):
- Antiplatelet medications and anticoagulants (warfarin, clopidogrel)
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Vitamin E supplements
- Fish oil and other omega-3 supplements
- Certain herbal supplements (ginkgo biloba, garlic, ginseng)
Most surgeons recommend discontinuing these medications at least 10 days before surgery, though specific timelines may vary based on individual circumstances.
Lifestyle Considerations
Smoking is a significant risk factor that can impair healing and increase complications. Patients are strongly advised to quit smoking at least 4-6 weeks before and after surgery to optimize healing potential.
Post-operative Care
Appropriate post-operative care is crucial for minimizing complications:
- Apply cold compresses to eyes for the first 48 hours (10 minutes per hour while awake)
- Keep your head elevated, especially during sleep, for at least 3-4 days
- Avoid bending, straining, and heavy lifting for at least one week
- Avoid rubbing the eyes or wearing contact lenses for at least two weeks
- Use prescribed eye ointments and drops as directed
- Avoid blood-thinning medications unless specifically approved by your surgeon
Managing Specific Complications
Dry Eye Management
Dry eye is common after blepharoplasty, with reported incidence rates as high as 26.5%. The likelihood increases when both upper and lower eyelid procedures are performed simultaneously (31.3%) compared to upper (12.9%) or lower (21.4%) blepharoplasty alone. For most individuals, symptoms resolve within 8 weeks.
Dry eye symptoms are managed according to severity:
- Mild cases: Preservative-free artificial tears
- Moderate cases: Ophthalmic gels and ointments, particularly at night
- Severe cases: May require additional treatments or procedures such as punctal occlusion (blocking the tear drainage channels)
Eyelid Malposition Management
The approach to eyelid malposition typically involves:
- Initial conservative management: Eyelid massage for minor cases, which may be effective for up to 6 months
- Surgical correction: Addressing specific causes in more severe cases through lid-shortening procedures or correction of vertical shortening
Warning Signs of Complications
Patients should seek immediate medical attention if they experience:
- Severe, new, or escalating eye pain
- Sudden or significant vision changes
- Bulging or proptosis of the eye
- Increasing redness, swelling, or discharge suggesting infection
- Persistent or brisk bleeding from incision sites
Choosing a Qualified Surgeon
Selecting a qualified Specialist Plastic Surgeon like Dr Scott J Turner is crucial for minimizing risks. Key factors in surgeon selection include:
- Appropriate qualifications and training in plastic surgery
- Experience specifically with blepharoplasty procedures
- Clear communication about potential risks and realistic outcomes
- Comprehensive pre-operative assessment protocols
- Dedication to ongoing patient care throughout the recovery process
Conclusion
Blepharoplasty can provide excellent results when performed on appropriate candidates by qualified surgeons. Understanding the potential risks and complications, as well as the importance of proper pre-operative assessment and post-operative care, helps ensure the best possible outcomes.
The procedure has a relatively low complication rate of approximately 9.5%, with most complications being minor and transient. However, patients should be fully informed about all potential risks, from common temporary side effects to rare but serious complications.
If you’re considering eyelid surgery, we encourage you to schedule a consultation with Dr Scott J Turner at one of our Sydney clinics to discuss your individual circumstances, concerns, and aesthetic goals.
For more information or to schedule a consultation, please contact us at our Manly or Double Bay locations.
Disclaimer: The information provided in this article is general in nature and intended for educational purposes only. It should not be considered medical advice. Every patient is unique, and individual results may vary. Potential risks and complications should be discussed in detail during a personal consultation with Dr. Scott J Turner. Surgical procedures carry inherent risks, and the decision to proceed with surgery should be made after careful consideration of both the benefits and possible complications. Always consult with a qualified Specialist Plastic Surgeon to determine whether blepharoplasty is appropriate for your specific situation.
