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Complications of Blepharoplasty

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Oculofacial, Orbital, and Lacrimal Surgery

Abstract

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.

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References

  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.

    Article  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  4. Liu CY, Samimi DB, Tao JP. Hemorrhagic complications of rivaroxaban after eyelid surgery. Ophthal Plast Reconstr Surg. 2016;32(1):74.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  7. Parikh M, Kwon YH. Vision loss after inadvertent corneal perforation during lid anesthesia. Ophthal Plast Reconstr Surg. 2011;27(5):e141–2.

    Article  PubMed  Google Scholar 

  8. Darlington JK, Lee WB, Schwab IR. Corneal perforation during laser blepharoplasty. Ophthalmic Surg Lasers Imaging. 2006;37(4):327–9.

    Article  PubMed  Google Scholar 

  9. Bleyen I, Rademaker R, Wolfs RC, van Rij G. Acute angle closure glaucoma after oculoplastic surgery. Orbit. 2008;27(1):49–50.

    Article  PubMed  Google Scholar 

  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. 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.

    Article  CAS  PubMed  Google Scholar 

  12. Good CD, Cassidy LM, Moseley IF, Sanders MD. Posterior optic nerve infarction after lower lid blepharoplasty. J Neuroophthalmol. 1999;19(3):176–9.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  14. Goldberg RA, Li TG. Postoperative infection with group A beta-hemolytic Streptococcus after blepharoplasty. Am J Ophthalmol. 2002;134(6):908–10.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  16. Kuipers T. Prophylactic antibiotics in plastic and reconstructive surgery. Plast Reconstr Surg. 2000;105:815–6.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  20. Baylis HI, Long JA, Groth MJ. Transconjunctival lower eyelid blepharoplasty. Technique and complications. Ophthalmology. 1989;96(7):1027–32.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  22. Pacella SJ, Nahai FR, Nahai F. Transconjunctival blepharoplasty for upper and lower eyelids. Plast Reconstr Surg. 2010;125(1):384–92.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  28. McCord CD, Miotto GC. Dynamic diagnosis of “fishmouthing” syndrome, an overlooked complication of blepharoplasty. Aesthet Surg J. 2013;33(4):497–504.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  30. Lowry JC, Bartley GB. Complications of blepharoplasty. Surv Ophthalmol. 1994;38(4):327–50.

    Article  CAS  PubMed  Google Scholar 

  31. McCord CD, Kreymerman P, Nahai F, Walrath JD. Management of postblepharoplasty chemosis. Aesthet Surg J. 2013;33(5):654–61.

    Article  PubMed  Google Scholar 

  32. Weinfeld AB, Burke R, Codner MA. The comprehensive management of chemosis following cosmetic lower blepharoplasty. Plast Reconstr Surg. 2008;122(2):579–86.

    Article  CAS  PubMed  Google Scholar 

  33. Woo KI, Choi CY. High-frequency radiowave electrosurgery for persistent conjunctival chemosis following cosmetic blepharoplasty. Plast Reconstr Surg. 2014;133(6):1336–42.

    Article  CAS  PubMed  Google Scholar 

  34. Hayworth RS, Lisman RD, Muchnick RS, Smith B. Diplopia following blepharoplasty. Ann Ophthalmol. 1984;16(5):448–51.

    CAS  PubMed  Google Scholar 

  35. Syniuta LA, Goldberg RA, Thacker NM, Rosenbaum AL. Acquired strabismus following cosmetic blepharoplasty. Plast Reconstr Surg. 2003;111(6):2053–9.

    Article  PubMed  Google Scholar 

  36. Jameson NA, Good WV, Hoyt CS. Fat adherence simulating inferior oblique palsy following blepharoplasty. Arch Ophthalmol. 1992;110:1369.

    Article  CAS  PubMed  Google Scholar 

  37. Wesley RE, Pollard ZF, McCord CD Jr. Superior oblique paresis after blepharoplasty. Plast Reconstr Surg. 1980;66(2):283–6.

    Article  CAS  PubMed  Google Scholar 

  38. Harley RD, Nelson LB, Flanagan JC, Calhoun JH. Ocular motility disturbances following cosmetic blepharoplasty. Arch Ophthalmol. 1986;104(4):542–4.

    Article  CAS  PubMed  Google Scholar 

  39. Ghabrial R, Lisman RD, Kane MA, Milite J, Richards R. Diplopia following transconjunctival blepharoplasty. Plast Reconstr Surg. 1998;102(4):1219–25.

    Article  CAS  PubMed  Google Scholar 

  40. Ortiz-Basso T, Vigo R, Prémoli EJ. Horizontal diplopia following upper blepharoplasty. Case Rep Ophthalmol. 2014;5(3):289–91.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Mazow ML, Avilla CW, Morales HJ. Restrictive horizontal strabismus following blepharoplasty. Am J Ophthalmol. 2006;141(4):773–4.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  43. Gupta S, Kalra A. Efficacy and safety of intralesional 5-fluorouracil in the treatment of keloids. Dermatology. 2002;204:130–2.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  46. Goldman MP. Festoon formation after infraorbital botulinum A toxin: a case report. Dermatol Surg. 2003;29:560–1.

    PubMed  Google Scholar 

  47. Pessa JE, Garza JR. The malar septum: the anatomic basis of malar mounds and malar edema. Aesthetic Surg J. 1997;17:11–7.

    Article  CAS  Google Scholar 

  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. 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. 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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  52. Kpodzo DS, Nahai F, McCord CD. Malar mounds and festoons: review of current management. Aesthet Surg J. 2014;34(2):235–48.

    Article  PubMed  Google Scholar 

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Correspondence to Richard D. Lisman .

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Callahan, A.B., Lisman, R.D. (2019). Complications of Blepharoplasty. In: Cohen, A., Burkat, C. (eds) Oculofacial, Orbital, and Lacrimal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-14092-2_22

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  • DOI: https://doi.org/10.1007/978-3-030-14092-2_22

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-14090-8

  • Online ISBN: 978-3-030-14092-2

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