Blepharoplasty surgery is not without risks. Though the vast majority of blepharoplasty patients in Denver, Colorado or the United States for that matter have surgery without complications, there are complications that do exist. It is important to be aware of these complications and how we minimize them in our Denver patients.

 

As a neuro-ophthalmologist along with oculoplastic surgeon, I have treated many patients who have been sent to me from complications from blepharoplasty.  I believe it has led me to approach my own blepharoplasty patients in Denver a safer less aggressive manner.

 

With every patient in Denver who recieves any surgery  I go over the risks and complications. I try to have a frank conversatiion to explain the most common risks and complications of eyelid surgery. Though these risks are not common but do exist so it is important for patients to be aware. Most importantly, they can then inform me if they believe they are suffering from one of the complications and know what to look out for. 

 

Eyelid surgery carries with it risks. Though most people do well, there are risks inherent to any surgery on the body, near the eye and on the eyelid. These are the most common that are applicable to oculoplastic surgery near the eyelid. Each surgery is independent of one another. So if a patient has an eyelid surgery on one eye and there were no complications, it does not mean it is less likely for a complication to occur on the other eye. 

 

The first group of risks are the ones that are inherent in all surgeries from eyelid, eye socket, hip and heart surgery. They are listed below and how they apply to the eyelid is described. 

 

BLEEDING
SCARRING 
INFECTION 
NEED FOR MORE SURGERY
PAIN

 

 

BLEEDING 

 

The eyelid is one of the most vascularized structure on the face.  The face in itself has a large network of blood vessels that supply it. During any procedure and the eyeld in particular any cut that is made on the skin can cut some of the blood vessels and cause bleeding. During surgery, this is controlled by the surgeon with cautery. We try to limit as much post operative bleeding as possible. Because blood vessels are cut, patients will have bruising and swelling after surgery. This is normal and to be expected. I often tell patients it will look like you got punched in the eye. A more important risk of eyelid surgery is a bleed behind the eye that puts pressure on the optic nerve. This can cause vision loss. To reduce these risks it is important to not perform any heavy lifting, bending, exercise or stooping after surgery. I encourage patients to relax and take it easy. Icing helps constrict blood vessels and reduce the chance of a bleed. Also, keeping the head elevated even when sleeping is helpful as well. If a patient is having a bleed, they should call me immediately. Delay in treatment can put pressure on the optic nerve of the eye and cause vision loss or blindness. The good news is that postoperative hemorrhages behind the eye are uncommon. The commonly cited incidence is .05% which means 1 in 2000.  

 

SCARRING

 

In eyelid surgery, the eyelid incisions or cuts are made in skin folds that are usually not visible. Most incisions soften with time and are not noticeable but some may be visible. Often there are secondary procedures that can be done to hide the scars even more but not always. Lastly, the incidence of keloids in the eyelids is extrememly rare but possible. Keloids are large scars that have to be excised. Other times small cysts can develop at the incision line. They tend to go away on their own but can be excised if they do not

 

INFECTION

The good news about the eyelids is that because of the blood supply we discussed earlier, the incidence of infection after eyelid surgery is very low. After surgery my patients are instructed to use antibiotic ointment and sometimes pills to reduce the risk of infection. If there is an infection after surgery, often we put patients on oral antibiotics to control the infection. 

NEED FOR MORE SURGERY

 

Any surgery that is done carries with it no guarantees. Every surgery I perform is done with care and careful attention however,  aach person's anatomy is different and may have changes that we cannot see until we are operating on it. Even the best surgeries carry with them the risk that they will not work and a further surgery will need to be done. Some surgeries such as ptosis surgery carries with a need to perform a second procedure between 10-20% of the time. Other eyelid surgeries have lower reoperation rates but there is no way to predict with 100% certainty if you will need a second procedure. Most people do not but that does not mean you will or wont'. I often tell patients that with certain eyelid procedures it is analogous to planting 10 seeds in a pot. I know that one of the seeds will not grow though it was planted and watered the same amount as the other seeds and everything was done right.  The need for more surgery can causes depression and sadness in some cases. 

 

PAIN 

After surgery, pain is expected. Often this lasts a few days and is managed with oral pain medicines during the recovery period. In rare cases, patients may have chronic pain from eyelid surgery. I have had patients who have been sent to me for a second opinion who have pain from eyelid surgery done several years ago. When I examine them, the eyelid surgery looks perfect and there is no explanation for the pain. I believe if you have pain syndromes such as fibromyalgia or a low pain threshold, you may be at more risk for this rare complication.

 

The next three complications or risks are more specific to eyelid surgery itself.

 

VISION LOSS
DOUBLE VISION

DRY EYES

 

VISION LOSS

 

Anytime we operate on the eyelid, eye socket, face or near the eye, there is a risk of vision loss or blindness. This can be from a hemorrhage or any multitude of causes. It is not common but is a risk that exists on any procedure around the eye.

 

DOUBLE VISION

 

Any surgery on the eyelid carries a risk of double vision. This can be from an eye muscle being inadvertently damaged during surgery from the local anesthetic or surgery. It can also be from the eyelid muscles indirectly changing the eye position.  Patients with dry eye can sometimes have double vision.

 

DRY EYES

 

Any surgery on the eyelids can make the eyes drier. Often this is seen in blepharoplasty or ptosis surgery as the eyelid height is raised and the eyes are more open but any surgery can cause the eyelids to not close properly. This can be from scarring or from tissue healing in an abnormal way. When patients have dry eyes it may be treated with eye drops that have to placed quite often or a punctal plug. A plug blocks the tears from draining from the eye surface and allows more tears to stay on the eye surface. In rare cases, a  patient's eye may not tolerate the eyelid surgery and have to be reversed so their eyes can close properly or not be dry. At most oculoplastic surgeons offices in DC patients are screened for dry eyes before the surgery.

 

ASYMMETRY OF APPEARANCE

 

During a blepharoplasty we attempt to make the eyelids more symmetrical as possible. That being said, there are limitations based on each patient’s anatomy and structure that can prevent a perfectly symmetrical result. Sometimes a small touchup procedure is needed that can be done in the office. Small differences between the eyelids are left alone usually.