Guidance before Blepharoplasty Surgery

1. Blepharoplasty surgeon will gather some or all of the following requirements well in advance of blepharoplasty date. These requirements are as follows:

a. You need to gather your health history and prepare questionnaire before blepharoplasty surgery.
b. Go for a basic physical examination for medical clearance with your regular physician.
c. Have some special physical testing or electrocardiogram.

2. Do not use any type of aspirin at least three weeks before blepharoplasty. Do not use other aspirin like baby aspirin, some cold remedies containing aspirin, any coated aspirin, or any medication related to ibuprofen like Motrin, Advil, Alleve, etc. These medications should be avoided at least three weeks before blepharoplasty. One tablet can hinder with your blood clotting before blepharoplasty. You can take tylenol at any time.

3. If you are advised for "blood thinners" like Coumadin or Plavix, discuss the same with your blepharoplasty surgeon in advance of blepharoplasty. You may need to follow some special instructions.

4. Stop using any type of separate Vitamin E supplement. You should stop Vitamin E atleast two weeks before blepharoplasty. A small amount of Vitamin E is not concerned.

5. Try to limit your over-the-counter supplements which are meant to protract bleeding to a lesser degree than the above medications. These over the counter supplements include gingko biloba, ginseng, glucosamine/ chrondroiton sulfate, and some herbs. So, try to limit the drinking of herbal teas or any over-the-counter supplements specifically which are not recommended by your regular doctor.

6. Talk to your blepharoplasty surgeon well in advance if you are taking any special regular medication. If you are using any diabetic dosage try to adjust it on the day of blepharoplasty.

7. It would be better if you stop smoking and alcohol intake atleast two weeks before blepharoplasty.

8. You should have some supplies before blepharoplasty. Sterile gauze pads, extra strength Tylenol and a little bottle of artificial tears.

9. You should purchase few supplies in advance which are ready for use after your blepharoplasty upon arrival at home. 2-3 tray of ice cubes, several clean washcloths and a small bowl for water. Also purchase a package of frozen baby peas or Ziploc bags to use ice packs.

Lower Blepharoplasty Functional Complications Treatment

“Malposition” is the most common functional complication of lower blepharoplasty. Malposition is a variation of the lower eyelid position, thus interaction with the relationship of eyeball with lower eyelid. This functional complication is due to:

1. Lower eyelid retraction
2. Cicatricial ectropion

Lower eyelid retraction is the pulling down of the eyelid thus exposing white of the eye “excessive sclera”. This excessive sclera creates a surgical looks. This functional complication commonly occurs when blepharoplasty is performed using a transcutaneous incision. The excessive scarring in the middle layers of the eyelid caused retraction. This mainly caused in lower blepharoplasty when transcutaneous approach is used as well as by the excessive skin and fat removal.

The Classical surgical approach for the correction of lower eyelid retraction is quite challenging and may require more than one operation. These are as follow:

1. Scar tissue severing
2. Lateral canthus tightening procedures
3. Dermal fat graft, ear cartilage grafting, hard palate tissue, decellularized tissue matrix called as spacer graft
4. Silicone cheek/orbital rim placement

These classical operations are often for a short duration only. In lower blepharoplasty, orbital fat deficiency has been observed as a major contributor to eyelid collapse.

Cicatrical ectropion is a functional complication in which lower eyelid is pulled away from eyeball. It is a common complication of lower blepharoplasty. Cicatrical Ectropion is caused due to excessive removal of fat and lower eyelid skin and it’s common in transcutaneous lower blepharoplasty. People those have stretched and weakened supporting tendons have high risk especially the smokers because the tightness is poorly tolerated and results in eyelid eversion.

Surgical treatment for cicatricial ectropion includes a difficult reconstructive operation in which grafting of donor skin with full thickness is require. Donor skin is taken from behind the ear. Some tightening techniques may also be required at lateral canthus or midface.

Lower Blepharoplasty Complications Treatment

Cosmetic Complications:

Lower blepharoplasty complications may result in the Patient dissatisfaction its final result. As in case of upper blepharoplasty, if inadequate skin from upper eyelid has been removed, the most direct cure is to excise a little more. However, skin excision will not provide a very effective solution to eliminate any wrinkles, while fanatic removal of lower eyelid skin in lower blepharoplasty will always cause considerable problems.

The most common cosmetic complication is inadequate removal of fat resulting in a visible bulge. Same in the case of fat transfer, it may result an inappropriately irregular shape and contour. These types of cosmetic complications in lower blepharoplasty can be addressed by the revision by transconjuctival approach. This is, however, the best approach to be conservative in case of fat removal.

The rare cosmetic complication in lower blepharoplasty is holloness which is caused due to excessive removal of lower eyelid fat. This complication be overcome by grafting of fat obtained from other part (usually behind the ear)of the body.

Treatment for Functional Complications of Upper Blepharoplasty

The most common functional complications caused by the upper blepharoplasty are includes:


1. Creation of droopy upper eyelid or Eyelid Ptosis
2. Lagophthalmos or shortage of tissue due to adequate prevention of closure


Eyelid Ptosis is a functional complication caused due to surgical injury to the levator muscle or aponeurosis (the lifting muscle and tendon) or placement of deep fixation causes tethering of levator action. Surgical injury includes the stretching or cutting of the tendon. The complication surgical injury can be repaired by the blepharoplasty specialist who has exposure in the eyelid reconstructive surgery. When sutures placed to a deep fixation it starts restrict the levator action. This tethering of levator action from sutures causes the eyelid ptosis. Such cases of the eyelid ptosis resolve fully without any additional surgery by the time of two to four weeks.

Lagophthalmos is a serious functional complication for eye surface health. The main reason for the lagophthalmos is excessive skin removal or internal scarring and results in inadequate eye closure. In some mild cases of lagophthalmos implantation of gold or platinum eyelid weight may designed to support eye closure. Massage is also a solution to repair eye closure. Typical cases of this complications are operated by the additional surgery. In this surgery new skin is grafted from a donor site (mostly behind the ear). Results of grafting are partial and cosmetically not perfect.

The catastrophic loss of vision is one of the most uncommon functional complications of upper blepharoplasty. This complication is caused due to build up of blood socket behind the eyeball. "Retrobulbar hemorrhage" can arise unexpectedly and is most commonly heralded by the beginning of very considerable pain and a graying of the vision. To resolve this functional complication, you need to go under treatment without any delay. To release any trapped blood Stitches may be removed and this will also open the wounds. The pressure from the eyeball needs to take off by allowing it to bulge forward. The removal of socket bone untying the orbit from the sinus cavities may help.

Treatment for Cosmetic Complications of Upper Blepharoplasty

Cosmetic complications in upper blepharoplasty are so-called as “Patient dissatisfaction” with the result. They can be categorized as the true impairment in eyelid and vision. The patient disappointment may be the result of:


- Unrealistic expectations
- Poor procedure used by an inexperienced blepharoplasty surgeon
- Asymmetric or Excess creases
- Under correction


Once blepharoplasty has been performed, the Unrealistic expectations by the patient are difficult problem to undue. The actual effective "treatment" for this is an honest and caution discussion between patient and his blepharoplasty surgeon. This discussion is about what can and cannot be attained by blepharoplasty.


Poor choice of procedure and execution by an inexperienced blepharoplasty surgeon can cause uneven results and excessive scarring. The approach to a more experienced blepharoplasty surgeon can retrace most of the steps of the surgery and can undertake correction as needed.


The upper two eyelids may be unmatched in height and shape after blepharoplasty due to Asymmetric or high creases in upper. This outcome is not rare. The same problem may not be related to blepharoplasty and can exist before the surgery. This can be caused by some separate problem (may be unrecognized) like brow drop and ptosis. To correct these deficiencies a patient has to elect a proper surgical method or he can simply ignore the imbalance between the two eyelids if it is soft. There is a fact that mild eyelid asymmetries are natural rather than any exception and this does not depend upon whether a person undergone blepharoplasty or not. The procedure to lower a crease is slightly complex. The crease may lower by the slight removal of additional skin usually accompanied by deep fixation.


There is a common reason why patient is dissatisfied, which is the overly conservative removal of upper eyelid skin. It is important for a blepharoplasty surgeon to accentuate that the prime goal of blepharoplasty is to enhance the looks without creating a bleak "surgical" look. Thus healthy conservatism will leave a patient slightly undercorrected. Fortunately, this problem can be easily corrected by the further excision of excess tissue and commonly, the skin needs to be removed and healing is rapid.


The blepharoplasty may results as hollowness and/or high eyelid crease when excessive fat removed from the upper eyelid. The procedure to repair this problem is quite difficult. To correct this fat grafts received from the patient's body can be implanted into a space formed between the closing muscle (orbicularis muscle) and opening muscle tendon (levator aponeurosis). This implant creates fullness and gives a tissue buffer to lower the crease. Such procedure is not entirely precise because of its limitation of scarring and survival of fat implanted. More than one technique may require achieving the best possible shape.