Infection: Infection is a risk with any type of surgery, including surgery on or around the eyelids.
Bleeding: Continued bleeding after blepharoplasty may require reopening of the eyelid wound and either cauterization of the bleeding vessel and/or evacuation of the clot.
Wound separation: The edges of the eyelid skin closure may separate, especially in the first day or two after suture removal. A small separation may close spontaneously or with the help of supporting tape. A larger separation may require suturing
Suture cysts: Tiny white cysts (milia) may develop in the suture line. While most disappear without treatment, removal of a resistant cyst is simple and quick.
Asymmetry: Eyelids that look good individually may not match as a pair, and such asymmetry introduced by surgery may be cosmetically disturbing. Asymmetries can involve the height and shape of the upper eyelid crease, excursion of the lower eyelid margin, residual skin or fat, and so on.
Insufficient skin removal: While blepharoplasty undercorrection is always preferable to overcorrection, an objectionable amount of undercorrection may call for more surgery.
Excessive skin removal: Excessive removal of upper eyelid skin may interfere with proper closure of the eyelids ("lagophthalmos") during blinking or especially when sleeping. Extreme shortage may distort the eyelid margin and create a widening of the palpebral fissure (opening between the eyelids) that is both cosmetically and functionally objectionable ("eyelid retraction"). Excessive removal of lower eyelid skin may cause the eyelid margin to pull away from the eye surface ("ectropion").
Insufficient fat removal: When insufficient fat removal creates a noticeable or asymmetric blemish, further removal may be indicated.
Excessive fat removal: Excessive fat removal from the upper eyelid may create a lid crease that appears too high and deep. Excessive fat removal in the lower eyelids may create a hollowed-out appearance.
Excessive internal scarring: Internal scarring or shrinkage of the internal eyelid layers below the skin may cause distortion, limitation of movement, and retraction.
Excessive external scarring: Scarring may be aggravated by poor or delayed healing in damaged or sensitive skin, improper placement of incisions, leaving sutures in too long, delayed healing after laser incisions, insufficient postoperative wound care, and other factors.
Drooping upper eyelid: Injury to the levator muscle and tendon (aponeurosis) may cause ptosis. Exploratory surgery may be indicated.
Double vision: If the muscles that move the eyeball are injured, temporary or permanent double vision may result.
Loss of vision: Very mild reduction of vision following blepharoplasty is not uncommon and is usually due to swelling, excessive tearing and mucus production, and/or secondary to ointments or drops used after surgery. Catastrophic loss of vision (that is, permanent blindness) occurs rarely (less than 1 in 10,000 cases) and is most often associated with brisk bleeding that makes its way to the area in back of the eyeball and generates enough pressure inside of the socket to cut off the normal blood flow to the retina.
Complications of anesthesia: Complications may occur from the anesthesia alone, including severe allergic reactions, blood pressure fluctuations, and serious heart and breathing difficulties. Such problems are more common with the administration of intravenous and/or inhaled anesthetic agents than with local anesthesia using oral sedation.
Unrealistic expectations: If your expectations are inappropriate or inflated for a certain operation because of your lack of preparation or your surgeon's lack of explanation, no matter how "perfect" the result may be from an objective point of view, you may not be satisfied.
