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Tips from Dr Bish Soliman to Avoid Complications with Blepharoplasty

Blepharoplasty, also known as eyelid surgery, is a cosmetic procedure that can change the appearance of eyes. By removing excess skin, muscle, and fat from the upper and lower eyelids, blepharoplasty can create a different look. It can also improve vision in cases where sagging upper eyelid skin obstructs the visual field. While blepharoplasty is generally a safe and effective operation when performed by a qualified plastic surgeon like Sydney Specialist Plastic Surgeon Dr Bish Soliman, it’s important to be aware that complications can occur, as with any surgical procedure. In this blog, we’ll discuss the potential complications associated with blepharoplasty and how you can minimise your risk.

Download Dr Bish Soliman’s Guide to Blepharoplasty Surgery

Ultimate Guide To Blepharoplasty

Potential Complications of Blepharoplasty

Complication 1: Bleeding/Haematoma

Bleeding and haematoma formation are the most common complications following blepharoplasty. A haematoma is a collection of blood that can occur under the skin after surgery, causing swelling, pain, and discolouration. The risk of bleeding and haematoma is increased in patients with high blood pressure, blood clotting disorders, and those taking blood-thinning medications such as aspirin or warfarin.

To minimise the risk of this complication, Dr Bish Soliman will perform a careful preoperative assessment, including a review of your medical history and medications. You may be advised to stop taking certain medications that increase the risk of bleeding, such as anti-inflammatory drugs and herbal supplements, for a period before and after surgery. During the procedure, meticulous surgical technique and cautious management of blood vessels can also help reduce the risk of bleeding.

If a haematoma does occur, it usually presents within the first 24 hours after surgery. Small haematomas can often be managed with cold compresses and close observation, while larger ones may require drainage in the operating theatre. Prompt recognition and treatment of a haematoma are important to prevent further complications and ensure the best possible outcome.

Complication 2: Infection

Infection is a rare but potentially serious complication that can occur after any surgical procedure, including blepharoplasty. Symptoms of infection may include redness, swelling, pain, discharge, and fever. The risk of infection can be minimised by performing the surgery in a sterile environment, using meticulous surgical technique, and administering preventive antibiotics when indicated.

After the procedure, you will be given detailed instructions on how to care for your incisions to promote healing and reduce the risk of infection. This may include cleaning the area gently, applying antibiotic ointment, and avoiding activities that could introduce bacteria to the surgical site, such as swimming or using makeup.

If an infection is suspected, prompt treatment with antibiotics is essential to prevent the spread of the infection and potential complications. Symptoms of infection should be reported to Dr Bish Soliman immediately so that appropriate treatment can be initiated. In rare cases, hospitalisation and intravenous antibiotics may be necessary to manage a severe infection.

Complication 3: Dry Eyes

Dry eyes can occur after blepharoplasty if the eyelids are unable to close completely due to swelling, muscle weakness, or overcorrection of the eyelid position. This can lead to exposure of the eye surface and a reduction in tear production, causing symptoms such as dryness, irritation, burning, and foreign body sensation.

To minimise the risk of dry eyes, Dr Bish Soliman will carefully assess your eyelid function and tear production before surgery and tailor the procedure to your individual needs. Conservative removal of skin and fat, and preservation of the natural eyelid contour, can help reduce the risk of eyelid malposition and incomplete closure.

If dry eyes do occur after surgery, artificial tears and lubricating ointments can help keep the eye surface moist and comfortable. Frequent use of these products, particularly before bed and upon waking, can prevent damage to the cornea and promote healing. In most cases, dry eye symptoms will resolve as the swelling subsides and eyelid function returns to normal. However, in some cases, prolonged use of lubricants or even temporary insertion of punctal plugs to block tear drainage may be necessary.

Complication 4: Asymmetry

Some degree of asymmetry is common after blepharoplasty and is usually due to differences in swelling, bruising, and healing between the two sides. Minor asymmetries are usually temporary and resolve as the healing process progresses. However, in some cases, asymmetry may be more noticeable or persistent, requiring additional surgical correction.

To minimise the risk of asymmetry, Dr Bish Soliman will assess your facial features and eyelid structure before surgery, taking precise measurements and using meticulous surgical technique to ensure a symmetrical result. Intraoperative comparison of the two sides and adjustment of the surgical plan as needed can also help achieve optimal symmetry.

If significant asymmetry is noted after surgery, it is important to allow adequate time for healing before considering revisional surgery. In many cases, asymmetry will improve as swelling resolves and the tissues settle into their final position. If asymmetry persists beyond 6-12 months, additional surgery may be recommended to correct the imbalance and achieve a more symmetrical result.

Complication 5: Scarring

All surgical procedures, including blepharoplasty, result in some degree of scarring. However, the incisions for blepharoplasty are typically placed within the natural creases of the eyelids, making the scars well-concealed and barely noticeable once healed. In some cases, particularly in patients with darker skin types or a history of abnormal scarring, more visible or prominent scars may develop.

To minimise the risk of visible scarring, Dr Bish Soliman will use fine, precise surgical techniques and place the incisions in the most inconspicuous locations possible. Meticulous closure of the incisions and careful postoperative care, including sun protection and avoidance of smoking, can also help promote optimal healing and minimise scarring.

In the early stages of healing, scars may appear red, raised, or firm. Over time, the scars will typically soften, flatten, and fade, becoming less noticeable. This process can take several months to a year or more, and patience is important during this time. If scars remain prominent or troublesome after the initial healing period, additional treatments such as topical medications, silicone gel or sheets, or scar massage may be recommended to improve their appearance.

Other Potential Complications

While bleeding, infection, dry eyes, asymmetry, and scarring are among the most common complications of blepharoplasty, there are several other potential risks and side effects that patients should be aware of before undergoing the procedure.

One of these is the risk of vision changes, which can occur due to a variety of factors. In rare cases, blepharoplasty may cause injury to the eye muscles or nerves, leading to double vision, blurred vision, or difficulty moving the eyes. Additionally, if too much skin is removed from the upper eyelids, it can result in difficulty closing the eyes completely, which can lead to corneal exposure and dryness. Patients with pre-existing eye conditions, such as glaucoma or dry eye syndrome, may be at increased risk of vision-related complications and should discuss these concerns with Dr Bish Soliman before surgery.

Another potential complication of blepharoplasty is eyelid malposition, which refers to a change in the position or shape of the eyelids after surgery. This can include ectropion, where the lower eyelid turns outward, or entropion, where the eyelid turns inward, causing the lashes to rub against the eye surface. Eyelid malposition can cause discomfort, irritation, and potentially damage to the cornea if left untreated. In most cases, eyelid malposition can be corrected with additional surgery to reposition the eyelid and restore normal function.

Patients may also experience temporary or permanent changes in sensation around the eyelids and surrounding skin after blepharoplasty. This can include numbness, tingling, or hypersensitivity, which may be more noticeable in the initial weeks after surgery. In rare cases, nerve damage may occur, leading to more prolonged or permanent changes in sensation. While these changes can be concerning, they typically improve over time as the nerves heal and regenerate.

As with any surgical procedure involving anaesthesia, there are also risks associated with the anaesthetic itself. These can include allergic reactions, breathing difficulties, nausea, and vomiting. Dr Bish Soliman will carefully review your medical history and discuss any previous reactions to anaesthesia to minimise the risk of complications. In some cases, additional precautions or monitoring may be necessary to ensure your safety during and after the procedure.

Other potential complications of blepharoplasty may include:

  • Chemosis: swelling of the conjunctiva, the thin membrane that covers the white of the eye
  • Milia: small, white cysts that can develop along the incision lines
  • Ptosis: drooping of the upper eyelid due to muscle weakness or nerve damage
  • Sunken or hollowed appearance: caused by excessive removal of fat or muscle from the eyelids
  • Watery eyes: due to temporary or permanent changes in tear drainage

While these complications are relatively rare, it is important for patients to be aware of them and to discuss any concerns or risk factors with Dr Bish Soliman before proceeding with blepharoplasty.

Minimising Your Risks

One of the most important steps you can take to minimise your risk of complications from blepharoplasty is to choose a highly qualified and experienced plastic. A skilled surgeon will have a thorough understanding of the anatomy of the eyelids and surrounding structures, as well as the technical expertise to perform the procedure safely and effectively. They will also have experience in recognising and managing potential complications, should they arise.

When considering a surgeon for your blepharoplasty, look for someone who is certified by the Royal Australasian College of Surgeons (RACS) and has completed specialised training in plastic and reconstructive surgery. Dr Bish Soliman is a Fellow of the Royal Australasian College of Surgeons (FRACS) and has undergone extensive training in both reconstructive and aesthetic surgery, including advanced techniques in blepharoplasty.

In addition to choosing a qualified surgeon, it is crucial to follow all pre and postoperative instructions closely to minimise your risk of complications. Before your surgery, Dr Bish Soliman will provide you with detailed instructions on how to prepare for the procedure, including any medications to avoid, dietary restrictions, and other precautions. It is essential to follow these instructions carefully to ensure that you are in the best possible health for your surgery.

One of the most important preoperative instructions is to stop smoking at least 6 weeks before your blepharoplasty. Smoking can significantly increase your risk of complications, including bleeding, infection, and delayed healing, by reducing blood flow to the tissues and impairing your body’s ability to heal. If you are a smoker, it is essential to quit well in advance of your surgery and to avoid smoking during the recovery period to ensure the best possible outcome.

Another important precaution is to avoid medications that can increase your risk of bleeding, such as aspirin, ibuprofen, and other non-steroidal anti-inflammatory drugs (NSAIDs), as well as certain herbal supplements like ginkgo biloba and vitamin E. Dr Bish Soliman will provide you with a list of medications to avoid before your surgery and will work with you to find alternative pain management options if necessary.

After your blepharoplasty, it is equally important to follow all postoperative instructions carefully to minimise your risk of complications. This may include applying cold compresses to reduce swelling, using prescribed eye drops or ointments to keep your eyes lubricated, avoiding strenuous activities or heavy lifting, and protecting your incisions from sun exposure. Dr Soliman and his team will provide you with detailed instructions on how to care for your eyes and incisions during the recovery period and will be available to answer any questions or concerns you may have.

FAQs about Complications of Eyelid Surgery

What are the most common complications of eyelid surgery (blepharoplasty)?

  • The most common complications of blepharoplasty include bleeding, infection, dry eyes, asymmetry, and scarring. While these complications are generally rare, it is important to be aware of them and to follow all pre and postoperative instructions carefully to minimise your risk.

How can I tell if I have an infection after my eyelid surgery?

  • Signs of infection after blepharoplasty may include redness, swelling, pain, discharge, and fever. If you experience any of these symptoms, it is important to contact Dr Soliman and his team immediately so that appropriate treatment can be initiated. Prompt treatment with antibiotics can help prevent the spread of infection and minimise the risk of further complications.

What should I do if I experience dry eyes after my eyelid surgery?

  • Dry eyes are a common side effect of blepharoplasty, particularly in the initial weeks after surgery. To manage dry eyes, Dr Soliman may recommend using artificial tears or lubricating ointments to keep your eyes moist and comfortable. It is important to use these products as directed and to avoid activities that can exacerbate dryness, such as spending long periods of time in front of a computer screen or in air-conditioned environments.

Can asymmetry after eyelid surgery be corrected?

  • Some degree of asymmetry is common after blepharoplasty and may resolve on its own as the swelling subsides and the tissues heal. However, if asymmetry persists or is particularly noticeable, it may require additional surgical correction.

How long does it take for scars to fade after eyelid surgery?

  • Scars from blepharoplasty typically take several months to a year to fully mature and fade. In the initial weeks after surgery, the scars may appear red, raised, or firm, but will gradually soften and become less noticeable over time. To promote optimal healing and minimise scarring, it is important to follow all postoperative instructions carefully, including protecting your incisions from sun exposure and avoiding smoking. If scars remain prominent or troublesome after the initial healing period, additional treatments such as topical medications or scar massage may be recommended.

Further Reading about Eyelid Surgery with Sydney Specialist Plastic Surgeon Dr Bish Soliman

Medical References about Complications of Eyelid Surgery

About Dr Bish Soliman

Dr Bish Soliman - Sydney Plastic and Reconstructive Surgeon, about us 01 2x
Specialist Plastic, Reconstructive and Cosmetic Surgeon
FRACS (Plas), MS (Plas), MBBS (Hons 1), BCom

AHPRA Registered Medical Practitioner MED 0001679053 Specialist Registration in Plastic Surgery

Dr Bish Soliman is a Sydney-based Specialist Plastic and Reconstructive Surgeon who performs aesthetic surgery of the face, breast, and body as well as skin cancer surgery.

He currently holds two consultant microsurgery positions in major Sydney hospitals performing complex microsurgical reconstruction including DIEP breast reconstruction.

After graduating from The King’s School, Dr Bish completed a Bachelor of Commerce degree at the University of Sydney. After working briefly at a major Sydney finance firm, he decided to pursue his passion and long-term goal of a career in medicine. He graduated from the University of Notre Dame at the top of his class, receiving First class honours and the prestigious Bower and Sherrard medal. He then went on to complete his junior medical training at Westmead Hospital during which time he was awarded Junior Medical Officer (JMO) of the Year, as well as a finalist for NSW Doctor of the Year.

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Next Steps

Do your Research

  • All Surgery has risks and potential complications. Please read the risks and complications page
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Making The Most Of Your Consultation

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