Eyelid surgery (blepharoplasty) is a common procedure that can improve both the functional and aesthetic appearance of the eyes. While most people recover well, it is important to understand potential risks and how to manage them. This article provides an educational overview of commonly reported complications and recovery considerations.
Bruising and Swelling After Eyelid Surgery
Postoperative bruising is expected and varies depending on individual factors, including natural skin tone and tissue sensitivity. It often resolves within 10-14 days. Avoiding blood-thinning medications and using cold compresses as advised can help reduce swelling and bruising.
Recurrent Skin Laxity After Upper Blepharoplasty
Recurrent skin laxity after upper blepharoplasty may occur as the frontalis muscle, previously lifting the brow, relaxes post-surgery. This can reveal underlying brow descent and contribute to the appearance of excess skin. Studies report brow descent in up to 58% of males and 29% of females following surgery. For patients with preoperative frontalis hyperactivity, surgical planning may involve brow assessment or neuromodulator use.
Bumps or Irregularities Along the Eyelid Incision
Small bumps or irregularities along the incision line are common after blepharoplasty. These may stem from normal healing processes such as swelling, scar formation, or suture reactions. Typically, they resolve over time with gentle massage and proper aftercare. Occasionally, fluid or scar-related nodules may feel more pronounced; while some will self-resolve, persistent or concerning changes, such as raised scars, persistent firmness, or signs of infection, should be evaluated by your surgeon.
Post‑Surgical Eyelid Asymmetry
Subtle asymmetry in eyelid shape or crease height is common, even before surgery, up to 93% of patients show natural differences. Minor differences after surgery (1–2 mm) are usually well tolerated and rarely require revision, and a well-executed blepharoplasty can also improve preexisting asymmetry. However, even with precise planning, some degree of lateral or medial asymmetry may occur. It’s important to discuss anticipated asymmetry during consults and ensure realistic expectations.
Lower Eyelid Malposition or Retraction
Lower eyelid malposition, such as retraction or, more rarely, ectropion, is a recognised risk after lower blepharoplasty. Around 15% of patients may experience retraction, while severe ectropion occurs in 0.2–1% of cases. Contributing factors include eyelid laxity, over-excision of skin, or lack of canthal support. Techniques like the transconjunctival approach or canthal suspension may reduce risk. Because malposition affects both appearance and function, early recognition is important.
Incomplete Eye Closure (Lagophthalmos)
Over-resection of upper eyelid skin can limit the ability to fully close the eyes, especially during sleep. This complication, known as lagophthalmos, may lead to symptoms such as dryness, irritation, and difficulty blinking. It is more likely to occur when excessive skin or supporting tissue is removed, particularly in patients with pre-existing eyelid tension or anatomy concerns. Although often temporary, persistent cases may require corrective measures. A conservative surgical approach and careful preoperative assessment help reduce the risk.
Dry Eyes, Irritation or Discomfort During Recovery
Dryness, irritation, and light sensitivity are common during early blepharoplasty recovery due to reduced blinking or mild eyelid retraction. These usually improve as swelling resolves. Lubricating drops and ointments may be used for comfort. Persistent symptoms should be discussed with your surgeon or ophthalmologist.
Corneal Irritation or Injury After Eyelid Surgery
Corneal irritation or abrasions can occur after blepharoplasty, especially if eyelid closure is incomplete or protective barriers are disrupted. Minor epithelial defects may cause discomfort, while in rare cases, exposed sutures can lead to abrasions or erosions, even years later. These typically respond well to lubricating drops or suture removal. Careful surgical technique and monitoring help reduce risk.
Hollow or Sunken Appearance After Fat Removal
Removing too much fat from the upper or lower eyelids can result in a hollowed, aged, or overly sculpted appearance. This complication has been reported in clinical literature and may occur when orbital fat is over-resected rather than preserved or repositioned. Evidence supports conservative fat management or augmentation techniques to maintain natural volume and contour. In some cases, corrective options such as fat grafting or filler may be considered if hollowing becomes noticeable. Careful preoperative planning and surgical judgment are essential to achieving a balanced and long-lasting result.
Vision Changes After Blepharoplasty
Blurred or double vision can occur after blepharoplasty but usually resolves within a few weeks as swelling decreases. Permanent vision changes are extremely rare, estimated at 0.0033% in large studies, while temporary changes affect about 0.0019%. Rarely, minor long-term effects like astigmatic shifts may persist, especially after combined procedures. Eyelid surgery may also influence corneal shape or tear film stability, underscoring the importance of thorough preoperative evaluation.
Infection Risk After Eyelid Surgery
Infection after eyelid surgery is uncommon, with most cases being mild and manageable using antibiotic ointments or oral medications. Reported rates range from 0.2% to 0.9%, especially if prophylaxis isn’t used or in complex procedures. Rarely, delayed infections such as mycobacterial or granulomatous reactions may occur and need specialist evaluation. Any persistent redness, swelling, or discharge should be assessed by your surgeon.
Eyelid Surgery
Dr Rodrigo Teixeira, MD, FRACS, is a Specialist Plastic Surgeon based in Melbourne, Australia, at Unveil Plastic Surgery in East Ivanhoe Village.
Dr Teixeira has extensive experience in both aesthetic and reconstructive surgery of the face, with a clinical focus on procedures such as facelift (meloplasty), blepharoplasty, and rhinoplasty.
He is a Fellow of the Royal Australasian College of Surgeons (RACS), and a member of the Australian Society of Plastic Surgeons (ASPS) and the Australasian Society of Aesthetic Plastic Surgeons (ASAPS). Internationally, he holds memberships in the American Society of Plastic Surgeons (ASPS), the International Society of Aesthetic Plastic Surgery (ISAPS), and is part of the faculty of the Anatomy for Injectors Course (afi)Â and the Mendelson Advanced Facial Anatomy Course (MAFAC).
Please note that any surgical or invasive procedure carries risks, and outcomes vary between individuals. If you have concerns about your facial appearance or are considering surgery, please speak with your general practitioner, who can provide a referral to a qualified Specialist Plastic Surgeon.
For further information, contact Unveil Plastic Surgery on (03) 9000 3800.
