ABSTRACT
There is a broad spectrum of complications that can occur following cosmetic eyelid surgery. The experienced eyelid surgeon should be able to avoid most serious complications through proper patient selection, a comprehensive preoperative assessment and surgical plan, meticulous surgical technique, and appropriate postoperative care. The aesthetic eyelid surgeon must counsel a patient contemplating blepharoplasty surgery regarding typical expectations including edema, eyelid numbness, dry eyes, and mild blurred vision. Patients must also be aware of the risks and the signs of serious complications such as infection, hematoma, or severe vision loss. Oculofacial surgeons must be capable of managing these adverse outcomes. The management of these urgent complications as well as other significant postoperative problems including diplopia, lagophthalmos, eyelid malposition, severe chemosis and edema, crease abnormalities, and wound dehiscence is outlined in this review.
KEYWORDS
Blepharoplasty - complications - cosmetic eyelid surgery - hematoma - vision loss
REFERENCES
-
1
Silkiss R Z.
Eight-fold path to happiness for the cosmetic surgery patient.
Ophthal Plast Reconstr Surg.
2006;
22
157-160
-
2
Holt J E, Holt G R.
Blepharoplasty: indications and preoperative assessment.
Arch Otolaryngol.
1985;
111
394-397
-
3
Adams J, Murray R.
The general approach to the difficult patient.
Emerg Med Clin North Am.
1998;
16
689-700
-
4
Jordan D R, Mawn L A.
Dysmorphophobia.
Can J Ophthalmol.
2003;
38
223-224
-
5
Mackley C L.
Body dysmorphic disorder.
Dermatol Surg.
2005;
31
553-558
-
6
McCullough M E, Emmons R A, Kilpatrick S D, Mooney C N.
Narcissists as ‘victims’: the role of narcissism in the perception of transgressions.
Pers Soc Psychol Bull.
2003;
29
885-893
-
7
Lewis C M, Lavell S, Simpson M F.
Patient selection and patient satisfaction.
Clin Plast Surg.
1983;
10
321-332
-
8
Hatton M P, Kelley J M, Rubin P AD.
Symmetry in healing after bilateral eyelid surgery.
Ophthal Plast Reconstr Surg.
2006;
22
266-268
-
9
Bartley G B, Warndahl R A.
Surgical bleeding associated with aspirin and nonsteroidal anti-inflammatory agents.
Mayo Clin Proc.
1992;
67
402-403
-
10
Ang-Lee M K, Moss J, Yuan C.
Herbal medicines and perioperative care.
JAMA.
2001;
286
208-216
-
11
Wolfort F G, Pan D, Gee J.
Alcohol and preoperative management.
Plast Reconstr Surg.
1996;
98
1306-1309
-
12
Knopf H.
Refractive distractions from drugs and disease.
Ophthalmol Clin North Am.
1993;
6
599-605
-
13
Burroughs J R, Patrinely J R, Nugent J S, Soparkar C NS, Anderson R L, Pennington J H.
Cold urticaria: an underrecognized cause of postsurgical periorbital swelling.
Ophthal Plast Reconstr Surg.
2005;
21
327-330
-
14
Holck D E, Dutton J J, Wehrly S R.
Changes in astigmatism after ptosis surgery measured by corneal topography.
Ophthal Plast Reconstr Surg.
1998;
14
151-158
-
15
Brown M S, Siegel I M, Lisman R D.
Prospective analysis of changes in corneal topography after upper eyelid surgery.
Ophthal Plast Reconstr Surg.
1999;
15
378-383
-
16
Shao W, Byrne P, Harrison A, Nelson E, Hilger P.
Persistent blurred vision after blepharoplasty and ptosis repair.
Arch Facial Plast Surg.
2004;
6
155-157
-
17
Oliva M S, Ahmadi A J, Mudumbai R, Hargiss J L, Sires B S.
Transient impaired vision, external ophthalmoplegia, and internal ophthalmoplegia after blepharoplasty under local anesthesia.
Am J Ophthalmol.
2003;
135
410-412
-
18
Wiggs E O.
Blepharoplasty complications.
Trans Am Acad Ophthalmol Otolaryngol.
1976;
81
603-606
-
19
Beekhuis G J.
Blepharoplasty.
Otolaryngol Clin North Am.
1980;
13
225-236
-
20
Shorr N, Cohen M S.
Cosmetic blepharoplasty.
Ophthalmol Clin North Am.
1991;
4
17-33
-
21
Hass A N, Penne R B, Stefanyszyn M A, Flanagan J C.
Incidence of postblepharoplasty orbital hemorrhage and associated visual loss.
Ophthal Plast Reconstr Surg.
2004;
20
426-432
-
22
Anderson R L, Edwards J J.
Bilateral visual loss after blepharoplasty.
Ann Plast Surg.
1980;
5
288-292
-
23
Goldberg R A, Marmor M F, Shorr N, Christenbury J D.
Blindness following blepharoplasty: two case reports, and a discussion of management.
Ophthalmic Surg.
1990;
21
85-89
-
24
Good C D, Cassidy L M, Moseley I F, Sanders M D.
Posterior optic nerve infarction after lower lid blepharoplasty.
J Neuroophthalmol.
1999;
19
176-179
-
25
Yachouh J, Arnaud D, Psomas C, Arnaud S, Goudot P.
Amaurosis after lower eyelid laser blepharoplasty.
Ophthal Plast Reconstr Surg.
2006;
22
214-235
-
26
Hartley Jr J H, Lester J C, Schatten W E.
Acute retrobulbar hemorrhage during elective blepharoplasty: its pathophysiology and management.
Plast Reconstr Surg.
1973;
52
8-12
-
27
Hueston J T, Heinze J B.
Successful early relief of blindness occurring after blepharoplasty: case report.
Plast Reconstr Surg.
1974;
53
588-592
-
28
Hueston J T, Heinze J B.
A second case of relief of blindness following blepharoplasty: case report.
Plast Reconstr Surg.
1977;
59
430-431
-
29
Kraushar M F, Seelenfreund M H, Freilich D B.
Central retinal artery closure during orbital hemorrhage from retrobulbar injection.
Trans Am Acad Ophthalmol Otolaryngol.
1974;
78
65-70
-
30
Putterman A M.
Temporary blindness after cosmetic blepharoplasty.
Am J Ophthalmol.
1975;
80
1081-1083
-
31
Heinze J B, Hueston J T.
Blindness after blepharoplasty: mechanism and early reversal.
Plast Reconstr Surg.
1978;
61
347-354
-
32
Kelly P W, May D R.
Central retinal artery occlusion following cosmetic blepharoplasty.
Br J Ophthalmol.
1980;
64
918-922
-
33
Fry H J.
Reversible visual loss after proptosis from retrobulbar hemorrhage.
Plast Reconstr Surg.
1969;
44
480-483
-
34
Huang T T, Horowitz B, Lewis S R.
Retrobulbar hemorrhage.
Plast Reconstr Surg.
1977;
59
39-44
-
35
Colton J J, Beekhuis G J.
Use of electrosurgery in blepharoplasty.
Arch Otolaryngol.
1985;
111
441-442
-
36
Tobin H A.
Electrosurgical blepharoplasty: a technique that questions conventional concepts of fat compartmentalization.
Ann Plast Surg.
1985;
14
59-63
-
37
David L M, Sanders G.
CO2 laser blepharoplasty: a comparison to cold steel and electrocautery.
J Dermatol Surg Oncol.
1987;
13
110-114
-
38
Sherman D D, Dortzbach R K.
Monopolar electrocautery dissection in ophthalmic plastic surgery.
Ophthal Plast Reconstr Surg.
1993;
9
143-147
-
39
Popp J C.
Complications of blepharoplasty and their management.
J Dermatol Surg Oncol.
1992;
18
1122-1126
-
40
Seckel B R, Kovanda C J, Cetrulo Jr C L, Passmore A K, Meneses P G, White T.
Laser blepharoplasty with transconjunctival orbicularis muscle/septum tightening and periocular skin resurfacing: a safe and advantageous technique.
Plast Reconstr Surg.
2000;
106
1127-1141
-
41
Münker R.
Laser blepharoplasty and periorbital laser skin resurfacing.
Facial Plast Surg.
2001;
17
209-217
-
42
Older J J.
The value of radiosurgery in oculoplastics.
Ophthal Plast Reconstr Surg.
2002;
18
214-218
-
43
Lemoine Jr A N.
Acute retrobulbar hemorrhage during elective blepharoplasty.
, (commentary)
Plast Reconstr Surg.
1973;
52
12-13
-
44
Rafaty F M.
Transient total blindness during cosmetic blepharoplasty: a case report and discussion.
Ann Plast Surg.
1979;
3
373-375
-
45
Callahan M A.
Prevention of blindness after blepharoplasty.
Ophthalmology.
1983;
90
1047-1051
-
46
Mahaffey P J, Wallace A F.
Blindness following cosmetic blepharoplasty-a review.
Br J Plast Surg.
1986;
39
213-221
-
47
Gorney M.
Claims prevention for the aesthetic surgeon: preparing for the less-than-perfect outcome.
Facial Plast Surg.
2002;
18
135-142
-
48
Adams B JS, Fuerstein S S.
Complications of blepharoplasty.
Ear Nose Throat J.
1986;
65
11-28
-
49
Castillo G D.
Management of blindness in the practice of cosmetic surgery.
Otolaryngol Head Neck Surg.
1989;
100
559-562
-
50
Lloyd III W C, Leone Jr C R.
Transient bilateral blindness following blepharoplasty.
Ophthal Plast Reconstr Surg.
1985;
1
29-34
-
51
Stasior O G.
Blindness associated with cosmetic blepharoplasty.
Clin Plast Surg.
1981;
8
793-795
-
52
Waller R R.
Is blindness a realistic complication in blepharoplasty procedures.
Ophthalmology.
1978;
85
730-735
-
53
Hayreh S S, Weingeist T A.
Experimental occlusion of the central artery of the retina I. Ophthalmoscopic and fluorescein fundus angiographic studies.
Br J Ophthalmol.
1980;
64
896-912
-
54
Yoon Y H, Marmor M F.
Dextromethorphan enhances ERG recovery after retinal ischemia.
Arch Ophthalmol.
1989;
107
409-411
-
55
Sacks S H, Lawson W, Edelstein D, Green R P.
Surgical treatment of blindness secondary to intraorbital hemorrhage.
Arch Otolaryngol Head Neck Surg.
1988;
114
801-803
-
56
Carter S R, Stewart J M, Khan J et al..
Infection after blepharoplasty with and without carbon dioxide laser resurfacing.
Ophthalmology.
2003;
110
1430-1432
-
57
Morgan S C.
Orbital cellulitis and blindness following a blepharoplasty.
Plast Reconstr Surg.
1979;
64
823-826
-
58
Jordan D R, Mawn L, Marshall D H.
Necrotizing fasciitis caused by group A Streptococcus infection after laser blepharoplasty.
Am J Ophthalmol.
1998;
125
265-266
-
59
Suner I J, Meldrum M L, Johnson T E, Tse D T.
Necrotizing fasciitis after cosmetic blepharoplasty.
Am J Ophthalmol.
1999;
128
367-368
-
60
Chen S H, Wang C H, Chen H C, Weng G C, Lin P Y, Wei F C.
Upper eyelid mycobacterial infection following Oriental blepharoplasty in a pulmonary tuberculosis patient.
Aesthetic Plast Surg.
2001;
25
295-298
-
61
Goldberg R A, Li T G.
Postoperative infection with group A beta-hemolytic Streptococcus after blepharoplasty.
Am J Ophthalmol.
2002;
134
908-910
-
62
Allen M V, Cohen K L, Grimson B S.
Orbital cellulitis secondary to dacryocystitis following blepharoplasty.
Ann Ophthalmol.
1985;
17
498-499
-
63
Rees T D, Craig S M, Fisher Y.
Orbital abscess following blepharoplasty.
Plast Reconstr Surg.
1984;
73
126-127
-
64
Kronish J W, McLeish W M.
Eyelid necrosis and periorbital necrotizing fasciitis.
Ophthalmology.
1991;
98
92-98
-
65
Rutar T, Chambers H F, Crawford J B et al..
Ophthalmic manifestations of infections caused by the USA300 clone of community-associated methicillin-resistant Staphylococcus aureus.
Ophthalmology.
2006;
113
1455-1462
-
66
Raghavan M, Linden P K.
Newer treatment options for skin and soft tissue infections.
Drugs.
2004;
64
1621-1642
-
67
Klapper S R, Patrinely J R, Kaplan S L, Font R L.
Atypical mycobacterial infection of the orbit.
Ophthalmology.
1995;
102
1536-1541
-
68
Moorthy R S, Rao N A.
Atypical mycobacterial wound infection after blepharoplasty.
Br J Ophthalmol.
1995;
79
93
-
69
Kevitch R, Guyuron B.
Mycobacterial infection following blepharoplasty.
Aesthetic Plast Surg.
1991;
15
229-232
-
70
Gonzalez-Fernandez F, Kaltreider S A.
Orbital lipogranulomatous inflammation harboring Mycobacterium abscessus.
Ophthal Plast Reconstr Surg.
2001;
17
374-380
-
71
Chang W J, Tse D T, Rosa Jr R H, Miller D.
Periocular atypical mycobacterial infections.
Ophthalmology.
1999;
106
86-90
-
72
Wanderer A A.
The spectrum of cold urticaria.
Immunol Allergy Clin North Am.
1995;
15
701-723
-
73
Lee C W, Sheffer A L.
Primary acquired cold urticaria.
Allergy Asthma Proc.
2003;
24
9-12
-
74
Wanderer A A, Grandel K E, Wasserman S I, Farr R S.
Clinical characteristics of cold-induced systemic reactions in acquired cold urticaria syndromes: recommendations for prevention of this complication and a proposal for a diagnostic classification of cold urticaria.
J Allergy Clin Immunol.
1986;
78
417-423
-
75
Baylis H I, Sutcliffe T, Fett D R.
Levator injury during blepharoplasty.
Arch Ophthalmol.
1984;
102
570-571
-
76
Rainin E A, Carlson B M.
Postoperative diplopia and ptosis: a clinical hypothesis based on the myotoxicity of local anesthetics.
Arch Ophthalmol.
1985;
103
1337-1339
-
77
Hornblass A.
Ptosis and pseudoptosis and blepharoplasty.
Clin Plast Surg.
1981;
8
811-830
-
78
Airiani S, Braunstein R E, Kazim M, Schrier A, Auran J D, Srinivasan B D.
Tegaderm transparent dressing (3M) for the treatment of chronic exposure keratopathy.
Ophthalmic Plast Reconstr Surg.
2003;
19
75-76
-
79
Chavez M, Putterman A M, Pak J.
Tegaderm transparent dressing (3M) for the treatment of chronic exposure keratopathy “Letter”.
Ophthal Plast Reconstr Surg.
2006;
22
236
-
80
McGraw M D, Adamson P A.
Postblepharoplasty ectropion: prevention and management.
Arch Otolaryngol Head Neck Surg.
1991;
117
852-856
-
81
Carraway J H, Mellow C G.
The prevention and treatment of lower lid ectropion following blepharoplasty.
Plast Reconstr Surg.
1990;
85
971-981
-
82
Wilkins R B, Byrd W A.
Complications of blepharoplasty.
Ophthal Plast Reconstr Surg.
1985;
1
195-198
-
83
Shorr N, Fallor M K.
“Madame Butterfly” procedure: combined cheek and lateral canthal suspension procedure for post-blepharoplasty, “round eye,” and lower eyelid retraction.
Ophthal Plast Reconstr Surg.
1985;
1
229-235
-
84
Patipa M.
The evaluation and management of lower eyelid retraction following cosmetic surgery.
Plast Reconstr Surg.
2000;
106
438-453
-
85
Patel B CK, Patipa M, Anderson R L, McLeish W.
Management of postblepharoplasty lower eyelid retraction with hard palate grafts and lateral tarsal strip.
Plast Reconstr Surg.
1997;
99
1251-1260
-
86
McCord Jr C D, Ellis D S.
The correction of lower lid malposition following lower lid blepharoplasty.
Plast Reconstr Surg.
1993;
92
1068-1072
-
87
Lisman R D, Hyde K, Smith B.
Complications of blepharoplasty.
Clin Plast Surg.
1988;
15
309-335
-
88
Levine M R, Davies R, Ross J.
Chemosis following blepharoplasty: an unusual complication.
Ophthalmic Surg.
1994;
25
593-596
-
89
Enzer Y R, Shorr N.
Medical and surgical management of chemosis after blepharoplasty.
Ophthal Plast Reconstr Surg.
1994;
10
57-63
-
90
Alfonso E, Levada A J, Flynn J T.
Inferior rectus paresis after secondary blepharoplasty.
Br J Ophthalmol.
1984;
68
535-537
-
91
Hayworth R S, Lisman R D, Muchnick R S, Smith B.
Diplopia following blepharoplasty.
Ann Ophthalmol.
1984;
16
448-451
-
92
Harley R D, Nelson L B, Flanagan J C, Calhoun J H.
Ocular motility disturbances following cosmetic blepharoplasty.
Arch Ophthalmol.
1986;
104
542-544
-
93
Baylis H I, Long J A, Groth M J.
Transconjunctival lower eyelid blepharoplasty: technique and complications.
Ophthalmology.
1989;
96
1027-1032
-
94
Ghabrial R, Lisman R D, Kane M A, Milite J, Richards R.
Diplopia following transconjunctival blepharoplasty.
Plast Reconstr Surg.
1998;
102
1219-1225
-
95
Syniuta L A, Goldberg R A, Thacker N M, Rosenbaum A L.
Acquired strabismus following cosmetic blepharoplasty.
Plast Reconstr Surg.
2003;
111
2053-2059
-
96
Levine M R, Boynton J, Tenzel R R, Miller G R.
Complications of blepharoplasty.
Ophthalmic Surg.
1975;
6
53-57
-
97
Wesley R E, Pollard Z F, McCord Jr C D.
Superior oblique paresis after blepharoplasty.
Plast Reconstr Surg.
1980;
66
283-286
-
98
Neely K A, Ernest J T, Mottier M.
Combined superior oblique paresis and Brown's syndrome after blepharoplasty.
, (letter)
Am J Ophthalmol.
1990;
109
347-349
-
99
Jordan D R, Anderson R L, Thiese S M.
Avoiding inferior oblique injury during lower blepharoplasty.
Arch Ophthalmol.
1989;
107
1382-1383
-
100
Patrinely J R, Marines H M, Anderson R L.
Skin flaps in periorbital reconstruction.
Surv Ophthalmol.
1987;
31
249-261
-
101
Jordan D R, Anderson R L.
Epicanthal folds: a deep tissue approach.
Arch Ophthalmol.
1989;
107
1532-1535
-
102
Yen M T, Jordan D R, Anderson R L.
No-scar Asian epicanthoplasty.
Ophthal Plast Reconstr Surg.
2002;
18
40-44
-
103
Scott K R, Tse D T, Kronish J W.
Vertically oriented upper eyelid nerves: a clinical, anatomical and immunohistochemical study.
Ophthalmology.
1992;
99
222-226
-
104
Black E H, Gladstone G J, Nesi F A.
Eyelid sensation after supratarsal lid crease incision.
Ophthal Plast Reconstr Surg.
2002;
18
45-49
-
105
Aszmann O C, Muse V, Dellon A L.
Evidence in support of collateral sprouting after sensory nerve resection.
Ann Plast Surg.
1996;
37
520-525
-
106
Aiache A E, Messler G.
Perisuture capsular contraction.
Plast Reconstr Surg.
2001;
107
1613-1614
-
107
Soll S M, Lisman R D, Charles N C, Palu R N.
Pyogenic granuloma after transconjunctival blepharoplasty: a case report.
Ophthal Plast Reconstr Surg.
1993;
9
298-301
-
108
Fryer R H, Reinke K R.
Pyogenic granuloma: a complication of transconjunctival incisions.
Plast Reconstr Surg.
2000;
105
1565-1566
Stephen R KlapperM.D. F.A.C.S.
Klapper Eyelid and Facial Plastic Surgery
13430 N. Meridian Street, #364, Carmel, IN 46032