What Are Some of the Risks and Complications of Eyelid Surgery?
Like every surgery, Eyelid Surgery has risks and complications. These will be minimized by precautions that your plastic surgeon will base upon your complete medical history, and through intermittent check ups following the surgery.
Blepharoplasty is a surgical procedure to remove excess skin and muscle from both the upper and lower eyelids. Underlying fatty tissue that produces bagginess can be selectively removed or repositioned. Blepharoplasty can improve drooping skin and bagginess. It can help improve vision in older patients who have hooding of their upper eyelids. Although it can add an upper eyelid crease to the Asian eyelid, it will not erase evidence of one’s racial or ethnic heritage. Blepharoplasty will not remove "crow's feet" or other wrinkles, eliminate dark circles under the eyes, or lift sagging eyebrows.
Blepharoplasty surgery is customized for every patient, depending on his or her particular needs. It can be performed alone involving upper, lower or both eyelid regions, or in conjunction with other surgical procedures of the eye, face, brow, or nose. In some patients, who have looseness between the lower eyelid and the eyeball, consideration for tightening of the lower eyelid (canthoplasty/ Canthopexy) at the time of blepharoplasty may be recommended. Eyelid surgery cannot stop the process of aging. It can however, diminish the look of loose skin and bagginess in the eyelid region.
RISKS OF BLEPHAROPLASTY SURGERY
Every surgical procedure involves a certain amount of risk and it is important that you understand these risks and the possible complications associated with them. In addition, every procedure has limitations. An individual's choice to undergo a surgical procedure is based on the comparison of the risk to potential benefit. Although the majority of patients do not experience these complications, you should discuss each of them with your plastic surgeon to make sure you understand all possible consequences of blepharoplasty surgery.
Infection is very unusual after surgery, especially since patients receive antibiotics during and after surgery. Should an infection occur, additional treatment including antibiotics, hospitalization, or additional surgery may be necessary.
It is possible, though unusual, to experience a bleeding episode during or after surgery. Bleeding may occur under the skin or internally around the eyeball. Should post-operative bleeding occur, it may require emergency treatment, surgery, or blood transfusion. Do not take any aspirin or anti-inflammatory medications for ten days before or after surgery, as this may increase the risk of bleeding. Non-prescription "herbs" and dietary supplements can increase the risk of surgical bleeding. Hypertension (high blood pressure) that is not under good medical control may cause bleeding during or after surgery. Accumulations of blood under the eyelids (hematoma) may delay healing and cause scarring. Hematoma can occur at any time following injury. Heparin medications that are used to prevent blood clots in veins can produce bleeding and decreased blood platelets.
Scarring and suture cysts
All surgery leaves scars, some more visible than others. Although good wound healing after a surgical procedure is expected, abnormal scars may occur within the eyelid and deeper tissues. Scars may be unattractive and of different color than the surrounding skin tone. Scar appearance may also vary within the same scar. Scars may be asymmetrical (appear different on the right and left side of the body). Deep scars can cause adhesions or cicatrix which can tether the eyelid. This can be corrected by massage, injections, or revision surgery.
There is the possibility of visible marks in the eyelid or small skin cysts from sutures-Milia. Most disappear without treatment; otherwise their removal is very simple. In some cases scars may require surgical revision or treatment.
Most surgical techniques use deep sutures. You may notice these sutures after your surgery. Sutures may spontaneously poke through the skin, become visible or produce irritation that requires removal. This can be done very simply in the office.
Wound disruption or delayed wound healing is possible. Some areas of the skin may not heal normally and may require re-suturing. Smokers have a greater risk of skin loss and wound healing complications.
The human face is normally asymmetrical. There can be a variation from one side to the other in the results obtained from blepharoplasty surgery. Additional surgery may be necessary to attempt to revise asymmetry.
You will experience pain after your surgery. Pain of varying intensity and duration may occur and persist after blepharoplasty surgery. Chronic pain may occur very infrequently from nerves becoming trapped in scar tissue.
Dry Eye Problems
Permanent disorders involving decreased tear production can occur after Blepharoplasty. The occurrence of this is rare and not entirely predictable. Individuals who normally have dry eyes may be advised to use special caution in considering Blepharoplasty surgery.
Displacement of the lower eyelid away from the eyeball is a rare complication. Precautions can be taken to prevent this during surgery. Otherwise, further surgery may be required to correct this condition- Canthopexy.
Corneal Exposure Problems
Some patients experience difficulties closing their eyelids after surgery and problems may occur in the cornea due to dryness. Should this rare complication occur, additional topical treatments and sometimes surgery may be necessary?
Eyelash Hair Loss
Hair loss may occur in the lower eyelash area where the skin was elevated during surgery. The occurrence of this is not predictable. Hair loss may be temporary or permanent.
Change in Skin Sensation
It is common to experience diminished (or loss) of skin sensation in areas that have had surgery. Diminished (or complete loss of skin sensation) may not totally resolve after a blepharoplasty.
Skin Contour Irregularities
Contour irregularities and depressions may occur after blepharoplasty. Visible and palpable wrinkling of skin can occur. Residual skin irregularities at the ends of the incisions or "dog ears" are always a possibility and may require additional surgery. This may improve with time, or it can be surgically corrected.
Insufficient Skin Removal
Depending on the tone of the eyelids during the surgical marking, just before the surgery, it is possible to underestimate the amount of eyelid skin to be removed. At other times early ptosis or drooping of the brows can result in small amount of remaining excess skin fold in the upper eyelid. This can be very easily corrected during an office "touch-up" procedure.
Excessive Skin Removal
Just as it is possible to remove too little skin, too much skin can also be removed due to overly aggressive skin marking prior to surgery, or underestimation of the laxity of the skin. Excessive removal of upper eyelid skin may interfere with the proper eyelid closure- Lagophtalmos. This will usually correct itself as the eyelid skin stretches with gravity. Never-the-less in some case it might require corrective surgery.
On the other hand, excessive removal of the lower eyelid skin can cause Ectropion. This can be temporary during the initial six to eight weeks of healing, but if it persists it can be treated by Canthopexy or non-surgical means.
Excessive Fat Removal
Over aggressive removal orbital fat can result in a hollowed eye look. While fat grafting can be attempted its resulted are marginal.
Inadequate Fat Removal
Insufficient removal of fat can create asymmetry which can be corrected by revision eyelid surgery.
Skin Discoloration / Swelling
Some bruising and swelling normally occurs following blepharoplasty. The skin in or near the surgical site can appear either lighter or darker than surrounding skin. Although uncommon, swelling and skin discoloration may persist for long periods of time and, in rare situations, may be permanent.
Itching, tenderness, or exaggerated responses to hot or cold temperatures may occur after surgery. Usually this resolves during healing, but in rare situations it may be chronic.
Suboptimal Placement of the Eyelid Crease
Excessive removal of upper eyelid skin and failure to adequately fixate the crease during suture closure in Asian eyelid surgery can result in superior migration of the crease which can deepen the fold and feminize the male eyelid.
Damage to Levator Muscle, its Aponeurosis, and the Muller's muscles can cause a Ptosis or sagging of the upper eyelids. It this condition persists after resolution of eyelid edema, it might require repair of the Levator Muscle and/or Aponeurosis.
Rounding of the eye
Rounding of the eye at the outer commisure or corner is a sequel of Canthopexy which needs to be pointed out to patients in advance of planned Canthopexy.
Swelling of the eye surface is common immediately after surgery, but if it persists it could be due to insufficient closure of the eyelids or lid retraction which needs to be corrected by patching/ pressure and/or revision surgery.
Injury to the Lacrimal System
During upper blepharoplasty the herniated lacrimal gland can be mistake to be excess fat and resected. This can cause persistent upper eyelid swelling and dryness of the eye.
During lower blepharoplasty the lacrimal ducts at the medial corner of the eyes can be injured. If noted during surgery it can be repaired. If this becomes apparent later its treatment depends on the functionality of the superior lacrimal system. If the superior lacrimal system can not adequately drain the tears then the inferior Lacrimal duct needs to be reconstructed.
Double vision or Diplopia can arise as a result of injury to the inferior oblique or superior oblique as well as the inferior rectus muscles. This might occur as a result of accidental injury to these muscles during removal of orbital fat. Correction of this will require specialized strabismus surgery. Allergic Reactions- In rare cases, local allergies to tape, suture materials and glues, blood products, topical preparations or injected agents have been reported. Serious systemic reactions including shock (anaphylaxis) may occur to drugs used during surgery and prescription medications. Allergic reactions may require additional treatment.
Both local and general anesthesia involves risk. There is the possibility of complications, injury, and rarely death from all forms of surgical anesthesia or sedation.
Blindness is extremely rare after blepharoplasty and occurs less than one in 10,000 cases. It is caused by sudden bleeding in the back of the eyeball (orbital or retrobulbar hemorrhage) which generates pressure on the optic nerve, and causes cessation of blood flow to the retina. Mostly it occurs during the initial 48 hours after surgery and is associated with sudden episode of hypertension or an overlooked bleeding point during surgery. Its preceding symptoms are hat of extreme eye pain, bulging of the eyes, excessive bleeding from the incisions and Diplopia. Once recognized it require immediate surgical decompression of the orbit to relieve pressure. If performed immediately, blindness can be reversed. Therefore, adequate post-operative monitoring in the surgery facility and home can prevent such a disaster.
Although good results are expected, there is no guarantee or warranty expressed or implied, on the results that may be obtained. You may be disappointed with the results of eyelid surgery. This would include risks such as asymmetry, unsatisfactory surgical scar location, unacceptable visible deformities, loss of function, poor healing, wound disruption, and loss of sensation. It may be necessary to perform additional surgery to improve your results. Additional surgical procedures such as a brow lift may be needed to correct eyebrow sagging which contributes to upper eyelid problems.
Cardiac and Pulmonary Complications
Surgery, especially longer procedures, may be associated with the formation of, or increase in, blood clots in the venous system. Pulmonary complications may occur secondarily to both blood clots (pulmonary emboli), fat deposits (fat emboli) or partial collapse of the lungs after general anesthesia. Pulmonary and fat emboli can be life-threatening or fatal in some circumstances. Air travel, inactivity and other conditions may increase the incidence of blood clots traveling to the lungs causing a major blood clot that may result in death. It is important to discuss with your physician any past history of blood clots or swollen legs that may contribute to this condition. Cardiac complications are a risk with any surgery and anesthesia, even in patients without symptoms. If you experience shortness of breath, chest pains, or unusual heart beats, seek medical attention immediately. Should any of these complications occur, you may require hospitalization and additional treatment.
Smoking, Second-Hand Smoke Exposure, Nicotine Products (Patch, Gum, Nasal Spray)
Patients who are currently smoking, use tobacco products, or nicotine products (patch, gum, or nasal spray) are at a greater risk for significant surgical complications of skin dying, delayed healing, and additional scarring. Individuals exposed to second-hand smoke are also at potential risk for similar complications attributable to nicotine exposure. Additionally, smoking may have a significant negative effect on anesthesia and recovery from anesthesia, with coughing and possibly increased bleeding. Individuals who are not exposed to tobacco smoke or nicotine-containing products have a significantly lower risk of this type of complication. Please indicate your current status regarding these items below:
Mental Health Disorders and Elective Surgery
It is important that all patients seeking to undergo elective surgery have realistic expectations that focus on improvement rather than perfection. Complications or less than satisfactory results are sometimes unavoidable, may require additional surgery and often are stressful. Please openly discuss with your surgeon, prior to surgery, any history that you may have of significant emotional depression or mental health disorders. Although many individuals may benefit psychologically from the results of elective surgery, effects on mental health cannot be accurately predicted.
Adverse Reaction to Medications
There are many adverse reactions that occur as the result of taking over-the-counter, herbal, and/or prescription medications. Be sure to check with your physician about any drug interactions that may exist with medications which you are already taking. If you have an adverse reaction, stop the drugs immediately and call your plastic surgeon for further instructions. If the reaction is severe, go immediately to the nearest emergency room. When taking the prescribed pain medications after surgery, realize that they can affect your thought process and coordination. Do not drive, do not operate complex equipment, do not make any important decisions, and do not drink any alcohol while taking these medications. Be sure to take your prescribed medication only as directed.