Side Effects of Blepharoplasty 

目 整形 失敗

Unfortunately, unwanted things happen after upper or lower blepharoplasty. If you had eyelid surgery for the first time, you might have no idea whether this is the usual process or early signs of the side effects. This article will classify the cases that can happen after surgery into three categories; spontaneous improvement as time passes, short-term follow-up required, and the surgical intervention needed. We will introduce some solutions to the listed problems also.

1. Spontaneously Improving Side Effects

1) Swelling and Bruising

double eyelid surgery swelling burising
Swelling and bruising after double eyelid surgery

Swelling and bruising are normal after eyelid surgery and vary among individuals. They typically improve with rest and compresses.
Cold (for the first three days) or warm (after three days) compresses are sufficient for faster recovery and we will share some tips to shorten the recovery periods.

2) Asymmetry

asymmetry after blepharoplasty
Asymmetry in initial phase usually disappears

Asymmetry is a common concern for patients, but it often improves over time as swelling subsides. Even a slight swelling can affect the lid shape as the eyelid skin is very thin. This susceptibility is why most early post-operative asymmetries are not a big concern, as it improves over time.

3) Scleral Show

The scleral show, excessive exposure of the white part of the eye, can occur after lower eyelid surgery. This symptom is a temporary issue that usually improves within a month. Sometimes, the initial results of this symptom can be proportional to the desired outcome in lateral lower enlargement or lateral canthoplasty: And the patient should accept some trade-offs in the early recovery period.

2. Short-term Follow-Up Required

1) Dry Eye Syndrome

tear film
Schema of tear in a microscopic layer

Some patients may experience dry eyes after blepharoplasty, but this usually resolves on its own or with artificial tears. If symptoms persist for over two months, IPL treatment may be considered. This symptom relates to a decrease in Meibomian gland function with age. (Randomised double-masked placebo-controlled trial of the cumulative treatment efficacy profile of intense pulsed light therapy for meibomian gland dysfunction).

2) Hematoma

plastic surgery hematoma
Upper : Pre and post after lower lid surgery. Hematoma has been found in 13th day of surgery.
Lower : 5 weeks and 5 months after surgical removal of hematoma.

Hematoma, bleeding inside the surgical site, can cause a mass-like lesion. If small, it will usually resolve on its own, but hyaluronidase injection may be done if large. Surgical drainage may be necessary if the size seems to get bigger.

3) Conjunctival Edema

plastic surgery complications sclera show
66-year-old male after subbrow lift, upper blepharoplasty, and lower eyelid surgery. Due to old age and a history of diabetes, the chemosis lasts longer than typical eyelid surgery. The slow progression of lower lid ectropion is also noted.

Conjunctival edema, also known as chemosis, can occur after lower blepharoplasty and usually resolves with time. Antibiotics or steroid eye drops may be helpful if it lasts more than two weeks.

3. Side Effects That May Require Surgical Intervention

Unfortunately, some side effects from eyelid surgery may require surgical correction. We will discuss some case examples of when revisional surgery may help alleviate symptoms.

1) Upper Eyelid Complications

             a) Lagophthalmos

lagophthalmos after brow lift
Pre and post brow lift photos of eye opening(upper) and closure(lower).
Sign of lagophthalmos that are shown on immediately after endoscopic forehead lift(middle in the lower row; a typical eyeball movement called bell’s phenomenon is shown during eye closures) has been resolved spontaneously on the 8th day(right side).

Lagophthalmos is a condition where the eyes do not close fully. In most cases, it improves spontaneously within 2 to 4 weeks. However, it can be more challenging to treat if it’s caused by excessive skin removal or over-correction during ptosis surgery. The timing and method of re-operation will depend on the individual case.
Risk factors for lagophthalmos include protruding eyes, hyperthyroidism, and the habit of opening your eyes while sleeping. Patients should discuss these conditions with their doctor before surgery.

             b) Retraction

plastic surgery side effects
Pre and post after ptosis surgery. Left eyes show retraction which needs to be corrected(middle). 2 months after correction of retraction deformity(bottom).

Retraction is a sign that the upper white part of the eyes is visible during a normal gaze. It can happen by over-correction of the levator muscle during blepharoptosis surgery. If this occurs in the early recovery phase, a surgeon can easily treat it. The best time for resolution is usually within 3 to 4 weeks of the first operation.

             c) Triple eyelid fold

A triple eyelid fold can occur when adhesions form in places other than the intended line and is often caused by excessive fat removal. Unlike retraction, it’s better to wait 6 months for surgical intervention.

             d) High lid crease

A high lid crease can cause “sausage-look eyes,” when the skin below the crease looks puffy. This appearance can be corrected with dual-plane dissection if the crease is designed too high.

2) Complications on the lower eyelids

             a) Lagophthalmos

Post-operative eyelid dysfunction after a dacryocystorhinostomy for nasolacrimal duct obstruction and related nerve.
Evaluation of Conventional Subciliary Incision Used in Blepharoplasty: Pre-operative and Post-operative Videography and Electromyography Findings.
Facial Nerve Supply to the Orbicularis Oculi around the Lower Eyelid: Anatomy and Its Clinical Implications 

Lagophthalmos can also occur after lower eyelid surgery and is caused by injury to the facial motor nerve during incision on the medial side of the eye muscle. If this happens after lower eyelid surgery, it often has short-term sequelae.

             b) ectropion

Lower lid eversion is divided into four types and ectropion(D) is the most frustrating sign for both patients and doctors.
Neligan Vol2. Ch10. Secondary blepharoplasty.

Ectropion is a rare but frustrating side effect after lower blepharoplasty, where the eyelids turn outward. It can be divided into two categories: those that require surgery and those that improve spontaneously. If there is a small gap between the lower lid and the orbit, spontaneous healing may occur and the small amount of sclera that shows may disappear. However, surgical correction is necessary if the red conjunctiva inside the orbit is noticeable.

ectropion correction
Before(left) and after(right) ectropion correction.

A 76-year-old man came to me with a complaint of eyelid eversion (ectropion) after lower eyelid surgery performed by an unknown surgeon. He mentioned that the previous surgeon had tried to correct the issue with a skin graft, but it did not improve the problem. I performed a lateral canthoplasty to correct the ectropion and am pleased with the results which have been well maintained.
When the eyes are closed, the ectropion causes a “fish mouth” appearance (as seen in the left middle image), and in a bird’s-eye view, the eyelid conjunctiva is not in contact with the eyeball (bottom left image).

4. Conclusion

This article discussed side effects that may occur after eyelid surgery and whether they can be resolved spontaneously or require medical or surgical treatment. Most patients’ concerns about their early results are often resolved over time. I hope this article provides relief for those worried about potential problems.

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