• unrealistic expectations
• poor execution
• asymmetric creases
• undercorrection
• Unrealistic expectations is a difficult problem. The only effective "treatment" is a discussion between patient and surgeon about what can and cannot be achieved by eyelid surgery.
• Poor execution by an inexperienced surgeon can yield a suboptimal result. The best approach is referral to a more experienced eyelid surgeon.
• Asymmetric creases is not uncommon. Sometimes the problem in unrelated to the surgery, per se, but rather caused by a preexisting imbalance, such as brow droop or ptosis.
• While conservative removal of upper eyelid skin may cause dissatisfaction, it is important to emphasize that the goal of blepharoplasty is to enhance appearance without creating a "surgical" look.
If too much fat is removed, the resulting hollowness is difficult to fix. The best revisional option appears to be orbital pearl fat grafting.
Complications causing functional impairment include:
• creation of a drooping eyelid
• tissue shortage preventing adequate closure
• Ptosis may be caused by injury to levator muscle or it tendon. If extreme, surgical exploration by an eyelid specialist may be indicated. On the other hand, mild ptosis usually resolves without intervention over a period of two to four weeks.
• Lagophthalmos, or poor eyelid closure, is a problem that may compromise the health of the eyeball. While milder cases may respond to massage, advanced cases require the grafting of skin.
• The most uncommon but drastic complication after upper (or lower) blepharoplasty is loss of vision due to a build up of blood in the socket behind the eyeball. "Retrobulbar hemorrhage" can be heralded by significant pain and a graying of vision. Treatment should be initiated immediately.
• Bleeding that remains localized within the eyelid and does not extend deeper into the orbit may form a clot. Most superficial "hematomas" are not a threat to vision but are sometimes removed to promote healing.
