Real Women, Real Concerns: Blepharoplasty Risks

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Choosing to undergo any kind of cosmetic procedure is a big decision. Even just considering a treatment can be downright scary. It’s natural to have questions and concerns and we want to help you feel most comfortable about your decision. That’s why each week the NewBeauty editors will reach out to one of our experienced board-certified doctors to get you the information you need to move forward.     

This week we reached out to New York oculoplastic surgeon Joseph A. Eviatar, MD to address one reader’s concern about blepharoplasty.

Reader concern: I am interested in getting a blepharoplasty but I'm not sure about the risks involved. What long-term risks and side effects should I take into consideration before making my decision?

Dr. Eviatar’s response:
When it comes to blepharoplasty, there are several things to consider.  It’s important that the doctor doing the procedure does not remove too much skin and fat because that can result in a hollowed look. 

First, you should have a frank discussion with your doctor on what you want your lids to look like. For example, if you want to restore the eyelids to look the way they did when you were younger, the fat may need to be repositioned rather than removed. Or, a minimal amount should be removed. If you want to change the shape of the eye and have more of an upper lid, the doctor should know. Also, consider the fold of the crease.  Do you want a tall platform to put make-up on or a more Asian appearing eye? Also, men’s eyes and women’s eyes are different.  People should take that into account too and whether the physician has done a lot of eyelid surgery on a lot of different types of eyelids. Look at their before and after cases and see if you can find a set of eyes similar to yours. If they have been treated in a way that gives a natural and improved result, you may have found a surgeon that knows how best to deal with your case.

The most common risks for blepharoplasty are bruising and swelling.  I use a laser for the procedure that minimizes downtime and bruising because it coagulates the tissue as it cuts. The laser is gentler on the tissue, which causes less bruising and bleeding. Often a transconjunctival approach (a technique where the cut is made through the eyelid, not through the skin) can be used and will also minimize downtime and bruising. Sutras are used on the upper lid and will be in place for about a week. There’s usually about 2 weeks of downtime. 

Other side effects can involve scarring and the upper or lower lids being pulled down.  Also, an inability to close the lids can happen if too much skin has been removed. Very rare side effects can include permanent double vision, bleeding behind the eye (which can cause blindness), potential scar tissue, and bad positioning (the lid position may be too open, too closed, or pulled down).  Generally about 5 % of patients need a touch up if there is unevenness between the two eyes. 

Over time, patients who have had fat recession can develop a hollowed appearance around the eyes that gives a skeletal appearance.  If you look at celebrities that have had their eyes done years ago, you can see a loss in volume around their eyes that causes the hollow look and makes their facial skeleton more prominent.  This is the main reason surgeons today have become very cautious about removing fat.  It is better to be conservative when performing blepharoplasty to avoid long-term consequences such as a hollowed appearance as the patient continues aging.

I think patients need to be cautious about eyelid surgery in general.  Make sure that it is the best option for you before proceeding.  Some patients get better results from filler under the lids or even in the upper lid.  If it’s a loss of volume that causes dark shadows or bags, particularly in younger patients, filler can be an excellent option and is much less invasive than surgery. 

Let us know your surgery concerns and questions here or on Facebook and Twitter and we'll do our best to get you answers. Just use #RealConcerns. 

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