Why does the eye close slowly (lagophthalmos) after a facelift or brow lift?
⚠️ Contact your surgeon urgently if you notice these signs
If after your procedure your eye cannot close completely, you feel eye pain or dryness, your vision becomes blurry, or your eye looks red or irritated, contact your surgeon the same day. An eye that stays open, even during sleep, can suffer serious damage to the cornea. If you cannot reach your surgeon and symptoms are severe, go to an emergency department.
Short answer
Slow or incomplete eye closure after a facelift or brow lift is called lagophthalmos. It can happen when surgery alters the tension or nerve supply around the eyelid, making it difficult for the eye to close fully. It is important to tell your surgeon right away, because an eye that cannot close properly can dry out and lead to serious corneal injury.
What the research shows
Lagophthalmos after facial surgery has more than one cause. One well-documented cause is brow lift surgery, where lifting the forehead skin or muscles changes how the upper eyelid sits and moves. A systematic review of 82 studies found that endoscopic brow lift techniques carried a 2.7% rate of lagophthalmos, making it one of the recognized complications of that procedure [5]. A separate case report described lagophthalmos appearing after a brow lift in patients who had also previously had upper eyelid surgery (blepharoplasty), because the combination left too little skin for the eye to close [8].
Another major cause is injury to or weakness of the facial nerve, which controls the muscle that closes the eye (orbicularis oculi). When this nerve does not work normally, the eyelid cannot close fully or quickly. Research on facial nerve palsy patients shows that lagophthalmos can be a lasting problem that requires its own treatment plan [6] [1] [3].
What this means for you
After a facelift or related procedure, mild swelling can temporarily make the eye feel different, but true lagophthalmos (the eye cannot close all the way) is a complication that needs prompt attention. The eye depends on blinking to stay moist and protected. Without complete closure, the cornea (the clear front of the eye) can dry out, become irritated, or even develop ulcers. Research on patients with this problem shows that lubricating eye drops and other treatments can help, but early reporting to your surgeon is key [1] [6].
What to ask your surgeon
Before surgery, it is worth asking: "Do I have any prior eyelid surgery or brow changes that could increase my risk of lagophthalmos?" Research shows that a history of upper eyelid surgery combined with a brow lift raises the risk [8]. Some surgeons also use careful preoperative planning, including assessment of eyelid position and skin laxity, to lower this risk [7]. After surgery, ask specifically what signs of incomplete eye closure to watch for and when to call the office.
Caveats
Most of the studies available focus on lagophthalmos caused by facial nerve palsy or by brow lift surgery specifically, rather than by standard facelift (rhytidectomy) alone [5] [8] [1] [3]. The evidence on this exact complication after a traditional facelift is limited in the abstracts reviewed, so the full picture may be broader than what this summary captures.