Complications of Blepharoplasty

  • Alison B. Callahan
  • Richard D. LismanEmail author


Blepharoplasty is one of the most common aesthetic surgeries performed by a variety of surgical specialists. Although blepharoplasty is a relatively straightforward procedure, as with any surgical procedure, complications can arise. Complications range from minor aesthetic nuances to vision-threatening emergencies. This article offers a comprehensive and up-to-date summary of complications arising from upper and lower eyelid blepharoplasties based on recent peer-reviewed literature and the professional experience of the authors. Careful preoperative evaluation, meticulous surgical decision-making, and prompt recognition and treatment of adverse events will minimize their occurrence and magnitude.


Blepharoplasty Complication Malposition Transcutaneous Transconjunctival 


  1. 1.
    DeMere M, Wood T, Austin W. Eye complications with blepharoplasty or other eyelid surgery. Natl Surv Plast Reconstr Surg. 1974;53(6):634–7.CrossRefGoogle Scholar
  2. 2.
    Hass AN, Penne RB, Stefanyszyn MA, Flanagan JC. Incidence of postblepharoplasty orbital hemorrhage and associated visual loss. Ophthal Plast Reconstr Surg. 2004;20(6):426–32.PubMedCrossRefGoogle Scholar
  3. 3.
    Teng CC, Reddy S, Wong JJ, Lisman RD. Retrobulbar hemorrhage nine days after cosmetic blepharoplasty resulting in permanent visual loss. Ophthal Plast Reconstr Surg. 2006;22(5):388–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Liu CY, Samimi DB, Tao JP. Hemorrhagic complications of rivaroxaban after eyelid surgery. Ophthal Plast Reconstr Surg. 2016;32(1):74.PubMedCrossRefGoogle Scholar
  5. 5.
    Anderson RL, Georgescu D, Vagefi MR, McMullan TF, Burroughs JR, McCann JD. To patch or not to patch? That is the question. Arch Facial Plast Surg. 2007;9(4):290–2.PubMedCrossRefGoogle Scholar
  6. 6.
    Lee KY, Tow S, Fong KS. Visual recovery following emergent orbital decompression in traumatic retrobulbar haemorrhage. Ann Acad Med Singap. 2006;35(11):831–2.PubMedGoogle Scholar
  7. 7.
    Parikh M, Kwon YH. Vision loss after inadvertent corneal perforation during lid anesthesia. Ophthal Plast Reconstr Surg. 2011;27(5):e141–2.PubMedCrossRefGoogle Scholar
  8. 8.
    Darlington JK, Lee WB, Schwab IR. Corneal perforation during laser blepharoplasty. Ophthalmic Surg Lasers Imaging. 2006;37(4):327–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Bleyen I, Rademaker R, Wolfs RC, van Rij G. Acute angle closure glaucoma after oculoplastic surgery. Orbit. 2008;27(1):49–50.PubMedCrossRefGoogle Scholar
  10. 10.
    Haverals K, Augustinus A, Hondeghem K. Bilateral acute angle-closure glaucoma after blepharoplasty. Bull Soc Belge Ophtalmol. 2010;316:59–61.Google Scholar
  11. 11.
    Kordic H, Flammer J, Mironow A, Killer HE. Perioperative posterior ischemic optic neuropathy as a rare complication of blepharoplasty. Ophthalmologica. 2005;219(3):185–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Good CD, Cassidy LM, Moseley IF, Sanders MD. Posterior optic nerve infarction after lower lid blepharoplasty. J Neuroophthalmol. 1999;19(3):176–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Chiu ES, Capell BC, Press R, Aston SJ, Jelks EB, Jelks GW. Successful management of orbital cellulitis and temporary visual loss after blepharoplasty. Plast Reconstr Surg. 2006;118(3):67e–72e.PubMedCrossRefGoogle Scholar
  14. 14.
    Goldberg RA, Li TG. Postoperative infection with group A beta-hemolytic Streptococcus after blepharoplasty. Am J Ophthalmol. 2002;134(6):908–10.PubMedCrossRefGoogle Scholar
  15. 15.
    Lazzeri D, Agostini T. Eyelid and periorbital necrotizing fasciitis as an early devastating complication of blepharoplasty. Plast Reconstr Surg. 2010;126(3):1112–3.PubMedCrossRefGoogle Scholar
  16. 16.
    Kuipers T. Prophylactic antibiotics in plastic and reconstructive surgery. Plast Reconstr Surg. 2000;105:815–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Fay A, Nallasamy N, Pemberton JD, Callahan A, Wladis EJ, Nguyen J, Durand ML, New England Oculoplastics Society Study Group. Prophylactic postoperative antibiotics for enucleation and evisceration. Ophthal Plast Reconstr Surg. 2013;29(4):281–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Belinsky I, Patel P, Charles NC, Lisman RD. Ointment granulomas following sutureless transconjunctival blepharoplasty: diagnosis and management. Ophthal Plast Reconstr Surg. 2015;31(4):282–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Hamawy AH, Farkas JP, Fagien S, Rohrich RJ. Preventing and managing dry eyes after periorbital surgery: a retrospective review. Plast Reconstr Surg. 2009;123(1):353–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Baylis HI, Long JA, Groth MJ. Transconjunctival lower eyelid blepharoplasty. Technique and complications. Ophthalmology. 1989;96(7):1027–32.PubMedCrossRefGoogle Scholar
  21. 21.
    Perkins SW, Dyer WK 2nd, Simo F. Transconjunctival approach to lower eyelid blepharoplasty. Experience, indications, and technique in 300 patients. Arch Otolaryngol Head Neck Surg. 1994;120(2):172–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Pacella SJ, Nahai FR, Nahai F. Transconjunctival blepharoplasty for upper and lower eyelids. Plast Reconstr Surg. 2010;125(1):384–92.PubMedCrossRefGoogle Scholar
  23. 23.
    Segal KL, Patel P, Levine B, Lisman RD, Lelli GJ. The effect of transconjunctival blepharoplasty on margin reflex distance 2. Aesthet Plast Surg. 2016;40(1):13–8.CrossRefGoogle Scholar
  24. 24.
    Carter SR, Seiff SR, Choo PH, Vallabhanath P. Lower eyelid CO(2) laser rejuvenation: a randomized, prospective clinical study. Ophthalmology. 2001;108(3):437–41.PubMedCrossRefGoogle Scholar
  25. 25.
    McKinney P, Zukowski ML, Mossie R. The fourth option: a novel approach to lower-lid blepharoplasty. Aesthet Plast Surg. 1991;15(4):293–6.CrossRefGoogle Scholar
  26. 26.
    Li TG, Shorr N, Goldberg RA. Comparison of the efficacy of hard palate grafts with acellular human dermis grafts in lower eyelid surgery. Plast Reconstr Surg. 2005;116(3):873–8; discussion 879–80.PubMedCrossRefGoogle Scholar
  27. 27.
    Baylis H, Perman K, Fett DR, Sutcliffe RT. Autogenous auricular cartilage grafting for lower eyelid retraction. Ophthal Plast Reconstr Surg. 1985;1(1):23–7.PubMedCrossRefGoogle Scholar
  28. 28.
    McCord CD, Miotto GC. Dynamic diagnosis of “fishmouthing” syndrome, an overlooked complication of blepharoplasty. Aesthet Surg J. 2013;33(4):497–504.PubMedCrossRefGoogle Scholar
  29. 29.
    Korn BS, Kikkawa DO, Schanzlin DJ. Blepharoplasty in the post-laser in situ keratomileusis patient: preoperative considerations to avoid dry eye syndrome. Plast Reconstr Surg. 2007;119(7):2232–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Lowry JC, Bartley GB. Complications of blepharoplasty. Surv Ophthalmol. 1994;38(4):327–50.PubMedCrossRefGoogle Scholar
  31. 31.
    McCord CD, Kreymerman P, Nahai F, Walrath JD. Management of postblepharoplasty chemosis. Aesthet Surg J. 2013;33(5):654–61.PubMedCrossRefGoogle Scholar
  32. 32.
    Weinfeld AB, Burke R, Codner MA. The comprehensive management of chemosis following cosmetic lower blepharoplasty. Plast Reconstr Surg. 2008;122(2):579–86.PubMedCrossRefGoogle Scholar
  33. 33.
    Woo KI, Choi CY. High-frequency radiowave electrosurgery for persistent conjunctival chemosis following cosmetic blepharoplasty. Plast Reconstr Surg. 2014;133(6):1336–42.PubMedCrossRefGoogle Scholar
  34. 34.
    Hayworth RS, Lisman RD, Muchnick RS, Smith B. Diplopia following blepharoplasty. Ann Ophthalmol. 1984;16(5):448–51.PubMedGoogle Scholar
  35. 35.
    Syniuta LA, Goldberg RA, Thacker NM, Rosenbaum AL. Acquired strabismus following cosmetic blepharoplasty. Plast Reconstr Surg. 2003;111(6):2053–9.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Jameson NA, Good WV, Hoyt CS. Fat adherence simulating inferior oblique palsy following blepharoplasty. Arch Ophthalmol. 1992;110:1369.PubMedCrossRefGoogle Scholar
  37. 37.
    Wesley RE, Pollard ZF, McCord CD Jr. Superior oblique paresis after blepharoplasty. Plast Reconstr Surg. 1980;66(2):283–6.PubMedCrossRefGoogle Scholar
  38. 38.
    Harley RD, Nelson LB, Flanagan JC, Calhoun JH. Ocular motility disturbances following cosmetic blepharoplasty. Arch Ophthalmol. 1986;104(4):542–4.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Ghabrial R, Lisman RD, Kane MA, Milite J, Richards R. Diplopia following transconjunctival blepharoplasty. Plast Reconstr Surg. 1998;102(4):1219–25.PubMedCrossRefGoogle Scholar
  40. 40.
    Ortiz-Basso T, Vigo R, Prémoli EJ. Horizontal diplopia following upper blepharoplasty. Case Rep Ophthalmol. 2014;5(3):289–91.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Mazow ML, Avilla CW, Morales HJ. Restrictive horizontal strabismus following blepharoplasty. Am J Ophthalmol. 2006;141(4):773–4.PubMedCrossRefGoogle Scholar
  42. 42.
    Kerwin LY, El Tal AK, Stiff MA, Fakhouri TM. Scar prevention and remodeling: a review of the medical, surgical, topical and light treatment approaches. Int J Dermatol. 2014;53(8):922–36.PubMedCrossRefGoogle Scholar
  43. 43.
    Gupta S, Kalra A. Efficacy and safety of intralesional 5-fluorouracil in the treatment of keloids. Dermatology. 2002;204:130–2.PubMedCrossRefGoogle Scholar
  44. 44.
    Ledon JA, Savas J, Franca K, Chacon A, Nouri K. Intralesional treatment for keloids and hypertrophic scars: a review. Dermatol Surg. 2013;39(12):1745–57.PubMedCrossRefGoogle Scholar
  45. 45.
    Yoo DB, Azizzadeh B, Massry GG. Injectable 5-FU with or without added steroid in periorbital skin grafting: initial observations. Ophthal Plast Reconstr Surg. 2015;31(2):122–6.PubMedCrossRefGoogle Scholar
  46. 46.
    Goldman MP. Festoon formation after infraorbital botulinum A toxin: a case report. Dermatol Surg. 2003;29:560–1.PubMedGoogle Scholar
  47. 47.
    Pessa JE, Garza JR. The malar septum: the anatomic basis of malar mounds and malar edema. Aesthetic Surg J. 1997;17:11–7.CrossRefGoogle Scholar
  48. 48.
    Petris C, Eviatar J, Lisman R. Filler problems: complications of periocular injection. In: Foad Nahai, editor. Problems in oculoplastic surgery: a repair manual. Thieme, New York: CRC Press; 2018.Google Scholar
  49. 49.
    Scheiner AJ, Baker SS. Laser treatment of festoons. In: Massry G, et al., editors. Master techniques in blepharoplasty and periorbital rejuvenation. New York: Springer; 2011.Google Scholar
  50. 50.
    Perry JD, Mehta VJ, Costin BR. Intralesional tetracycline injection for treatment of lower eyelid festoons: a preliminary report. Ophthal Plast Reconstr Surg. 2015;31(1):50–2.PubMedCrossRefGoogle Scholar
  51. 51.
    Liapakis IE, Paschalis EI. Liposuction and suspension of the orbicularis oculi for the correction of persistent malar bags: description of technique and report of a case. Aesthet Plast Surg. 2012;36:546–9.CrossRefGoogle Scholar
  52. 52.
    Kpodzo DS, Nahai F, McCord CD. Malar mounds and festoons: review of current management. Aesthet Surg J. 2014;34(2):235–48.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Tufts Medical Center, OphthalmologyBostonUSA
  2. 2.Ophthalmology/Plastic SurgeryNYU School of MedicineNew YorkUSA
  3. 3.Ophthalmology/Plastic SurgeryManhattan Eye, Ear and Throat HospitalNew YorkUSA

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