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Complications of upper eyelid plasty (blepharoplasty)

Medical expert of the article

Ophthalmologist
, Medical Reviewer, Editor
Last reviewed: 08.07.2025

Natural transient consequences of upper eyelid surgery include erythema along the incision, a feeling of tension or minimal friction, numbness, and swelling of the eyelids, more noticeable in the lateral half of the surgical wound.

  • Hematoma

Hematoma rarely develops after upper eyelid surgery. Suspicion of hematoma may arise if unilateral edema and discoloration of the skin develops immediately after surgery. In such cases, the wound should be opened. The bleeding vessel is cauterized and the wound is sutured again.

  • Subconjunctival hemorrhages

Subconjunctival hemorrhages are uncommon. Although they are usually disturbing to patients, the problem appears to be purely cosmetic. The patient should be reassured that the whiteness of the eye will return with time. Redness persists for 3 weeks or more.

  • Chemosis

Chemosis (swelling of the conjunctiva) is rare in the upper eyelid. It may be present for up to 6 weeks after surgery. In most cases, its manifestations are quickly relieved by the use of Blephamide eye drops.

  • Lagophthalmos

Lagophthalmos is present briefly after surgery in many cases. It is the most likely cause of the transient burning and rubbing sensation reported by some patients. The use of an ophthalmic ointment and then daily use of artificial tears and ointment suppresses the symptoms during the healing period. Persistent lagophthalmos may lead to the development of dry eye. Surgical interference with the protective mechanism of the upper eyelid to the cornea is a serious problem that most often arises when upper eyelid surgery is performed simultaneously with a forehead lift or in secondary upper eyelid surgery. It is difficult to determine the degree of upper eyelid tissue redundancy during a forehead lift. It is never a mistake to perform upper eyelid surgery several months after a forehead lift. Most acute problems resolve with time, but artificial tears, nightly lid seals, and ophthalmologist supervision are often needed.

  • Bad scars

Visible scars on the lateral aspect of the upper eyelids may occur if wound dehiscence is not recognized after suture removal or if there is sun exposure causing wound pigmentation. In either case, delayed excision and closure may be necessary. Bad medial scars are always caused by excessive skin excision or by unforeseen removal of large amounts of fat, which, when the wound is closed, results in skin being pulled over dead space. Such scars are best treated with triamcinolone injections (Kenalog 10 mg/ml).

  • Loss of vision

Most known cases of vision loss are due to hematoma formation after upper or lower eyelid surgery. This usually occurs in elderly patients, with hypertension, anticoagulant therapy, and metabolic diseases. Vision loss after bleeding during upper eyelid surgery is extremely rare. In all cases, rapid decompression of the growing retrobulbar hematoma is necessary.

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