What are the most common blepharoplasty complications?
⚠️ Seek urgent care for these warning signs
After blepharoplasty, contact your surgeon or go to an emergency room immediately if you experience sudden or worsening pain in or around the eye, rapidly increasing swelling or bruising, any change in your vision (blurring, double vision, or vision loss), or an inability to close your eye fully. These symptoms could signal a retrobulbar hemorrhage or other serious complication that requires prompt treatment to protect your sight.
Short answer
Blepharoplasty complications range from minor and temporary to rare but serious. The most common issues include dry eye symptoms, eyelid malposition, scarring, and swelling. The most serious, though rare, complication is retrobulbar hemorrhage (bleeding behind the eye), which can threaten vision. Most complications are preventable with careful surgical planning and technique.
What the research shows
Multiple reviews of blepharoplasty complications group them by when they tend to appear after surgery [3]:
- Early (first week): Corneal abrasions (scratches on the eye surface) and retrobulbar hemorrhage (bleeding behind the eye), which is rare but the most vision-threatening complication [3] [6].
- Intermediate (weeks 1 to 6): Eyelid malposition (the eyelid sitting too high or too low), strabismus (eye misalignment), corneal exposure, and epiphora (excessive tearing) [3] [5].
- Late (after 6 weeks): Changes in eyelid height or shape, asymmetry between the two eyes, scarring, and persistent swelling [3].
Dry eye symptoms are also a recognized complication. Interestingly, a meta-analysis of randomized controlled trials found that upper blepharoplasty actually reduced dry eye symptoms overall compared to before surgery. However, removing both skin and muscle (rather than skin alone) raised the risk of lagophthalmos, a condition where the eyelid cannot fully close [2].
Other reviewed complications include infection, ptosis (drooping eyelid), lacrimal gland injury, and residual excess skin [6]. Vision loss, while rare, can result from optic nerve issues or eye compression from bleeding [5].
How common are serious complications?
The overall reassuring message from the literature is that most blepharoplasty complications are infrequent, minor, and temporary [5] [7]. Serious and permanent complications, such as significant vision loss, are rare. Cosmetic concerns (like asymmetry or scarring), functional concerns (like trouble closing the eye), and comfort issues (like dryness or irritation) are the three main categories patients tend to worry about [4].
Surgical technique makes a real difference. For example, continuous suturing raised eye irritation risk compared to a different suture method, and muscle-sparing approaches reduced the chance of lagophthalmos [2]. Careful screening of patients before surgery also helps prevent many complications [5].
What to ask your surgeon
Before your procedure, consider asking your surgeon these questions:
- What specific technique will you use, and how does it reduce the risk of dry eye or eyelid closure problems?
- Am I at higher risk for any complications based on my eye health history?
- What does the normal recovery look like, and what symptoms should prompt me to call you right away?
- How many blepharoplasties have you performed, and what is your personal complication rate?
Being well-informed before surgery is one of the best ways to ensure a safe outcome [6] [8].
Caveats
Most of the studies behind this information are expert narrative or cohort reviews rather than large randomized trials, so exact complication rates vary across sources [3] [4] [5] [6] [7] [8]. The one meta-analysis of randomized trials focused mainly on dry eye and lagophthalmos outcomes in upper blepharoplasty, so it does not cover all possible complications [2]. Your personal risk will depend on your individual anatomy, eye health, and your surgeon's experience and technique.