Management of cosmetic eyelid surgery complications

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.

Figure 1

(A) A 60-year-old woman with upper eyelid ptosis and dermatochalasis. (B) Hematoma of left of upper eyelid 6 hours following bilateral upper eyelid blepharoplasty and ptosis repair. (C) Final postoperative appearance following evacuation of hematoma and subsequent ptosis revision surgery.

Figure 2

A 73-year-old woman with right upper eyelid induration, erythema, and edema 2 days following bilateral upper eyelid blepharoplasty and ptosis repair. Cultures of mucopurulent drainage grew methicillin-resistant Staphylococcus aureus.

Figure 3

(A) A 59-year-old man with brow ptosis and severe dermatochalasis. (B) Mild left upper eyelid ptosis evident following uncomplicated brow ptosis repair and upper eyelid blepharoplasty.

Figure 4

(A) Bilateral calcific band keratopathy due to lagophthalmos and chronic corneal exposure. (B) Upper and lower eyelid full-thickness skin grafting required to improve eyelid closure and allow for keratoplasty and visual rehabilitation.

Figure 5

(A) A 37-year-old woman with asymmetric upper eyelid crease height following blepharoplasty. (B) Improved crease symmetry following insertion of Alloderm^® graft and refixation of left upper eyelid crease.

Figure 6

Erythematous nodule along the incision line representing encapsulation around a suture (suture granuloma).

Figure 7

(A) Lateral canthal pyogenic granuloma following canthoplasty. (B)Lower eyelid pyogenic granuloma following transconjunctival blepharoplasty.