Eyelid surgery (blepharoplasty) is a common procedure. It can improve both how the eyes work and how they look. Most people recover well. Still, it is important to understand the possible risks and how to manage them. This article gives an overview of complications that are often reported, and key points about recovery.
Bruising and Swelling After Eyelid Surgery
Bruising after surgery is expected. It varies with personal factors, such as natural skin tone and tissue sensitivity. It often settles within one to two weeks. Avoiding blood-thinning medicines can help reduce swelling and bruising. So can using cold compresses as advised.
Recurrent Skin Laxity After Upper Blepharoplasty
Skin laxity may come back after upper blepharoplasty. This can happen as the frontalis muscle, which was lifting the brow, relaxes after surgery. This can reveal underlying brow descent and add to the look of excess skin. On average, the brow sits only slightly lower after surgery. A 2023 review of 17 studies found an average drop of less than 1 mm after upper blepharoplasty. The change can be more noticeable in people who were lifting their brows before surgery. Some patients have an overactive frontalis muscle before surgery. For them, 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 come from normal healing, such as swelling, scar formation, or reactions to sutures. They usually settle over time with gentle massage and proper aftercare. Sometimes, fluid or scar-related nodules may feel more marked. Some will settle on their own. Some changes should be checked by your surgeon. These include changes that persist or concern you, such as raised scars, ongoing firmness, or signs of infection.
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. They rarely need revision. A well-performed blepharoplasty can also improve asymmetry that was there before. But even with precise planning, some lateral or medial asymmetry may occur. It’s important to discuss expected asymmetry during consults. It’s also important to make sure expectations are realistic.
Lower Eyelid Malposition or Retraction
Lower eyelid malposition is a recognised risk after lower blepharoplasty. This includes retraction or, more rarely, ectropion. Reported rates vary widely with the technique used and how loose the eyelid is. Most cases are mild, but some need further surgery. Factors that add to the risk include eyelid laxity, removing too much skin, or lack of canthal support. Techniques like the transconjunctival approach or canthal suspension may reduce risk. Malposition affects both how the eyelid looks and how it works. So spotting it early is important.
Incomplete Eye Closure (Lagophthalmos)
Removing too much upper eyelid skin can limit how fully the eyes close, especially during sleep. This complication is known as lagophthalmos. It may lead to symptoms such as dryness, irritation, and difficulty blinking. It is more likely when too much skin or supporting tissue is removed. This is especially so in patients with existing eyelid tension or anatomy concerns.
It is often temporary, but persistent cases may need corrective measures. A conservative surgical approach and careful assessment before surgery help reduce the risk.
Dry Eyes, Irritation or Discomfort During Recovery
Dryness, irritation, and light sensitivity are common early in blepharoplasty recovery. This is due to reduced blinking or mild eyelid retraction. These usually improve as swelling settles. Lubricating drops and ointments may be used for comfort. Symptoms that persist should be discussed with your surgeon or ophthalmologist.
Corneal Irritation or Injury After Eyelid Surgery
Corneal irritation or abrasions can occur after blepharoplasty. This is especially so if the eyelids do not fully close or protective barriers are disrupted. Minor epithelial defects may cause discomfort. In rare cases, exposed sutures can lead to abrasions or erosions, even years later. These usually 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 cause problems. The eyes may look hollow, aged, or overly sculpted. This complication has been reported in clinical literature. It may occur when too much orbital fat is removed rather than kept or repositioned. Evidence supports conservative fat management or augmentation techniques. These aim to keep natural volume and contour.
If hollowing becomes noticeable, options such as fat grafting or filler may be considered in some cases. Careful planning before surgery and sound surgical judgment are essential for a balanced and long-lasting result.
Vision Changes After Blepharoplasty
Blurred or double vision can occur after blepharoplasty. It usually resolves within a few weeks as swelling goes down. Bleeding behind the eye (orbital haemorrhage) is rare. A US survey of more than 269,000 eyelid operations found it in about 1 in 2,000 cases. Permanent loss of vision was very rare, about 1 in 22,000. Severe or increasing pain, a bulging eye or reduced vision needs urgent assessment. Rarely, minor long-term effects like astigmatic shifts may persist, especially after combined procedures. Eyelid surgery may also affect corneal shape or tear film stability. This is why a thorough evaluation before surgery is important.
Infection Risk After Eyelid Surgery
Infection after eyelid surgery is uncommon. Most cases are mild and can be managed with antibiotic ointments or oral medicines. 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. These need assessment by your surgeon. Any redness, swelling, or discharge that persists should be assessed by your surgeon.
Learn more about eyelid surgery in Melbourne.
Related reading: Exploring Upper Eyelid Surgery: Common Concerns, Timing, Expectations and Recovery and Lower Eyelid Surgery: Under-Eye Bags & Tear Trough Treatment Guide.
Dr Rodrigo Teixeira is a Specialist Plastic Surgeon in Melbourne whose practice is focused on facelift and facial surgery, including neck lift, eyelid and brow surgery, rhinoplasty and facial fat transfer. His approach is anatomy-led, with careful assessment and treatment planning tailored to the individual. He is a Fellow of the Royal Australasian College of Surgeons (FRACS, Plastic and Reconstructive Surgery). He is a member of the Australian Society of Plastic Surgeons, the Australasian Society of Aesthetic Plastic Surgeons, the American Society of Plastic Surgeons and the International Society of Aesthetic Plastic Surgery (ISAPS), and a faculty member of the Mendelson Advanced Facial Anatomy Course (MAFAC).
Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner. 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.