Key Points

•An appropriate preoperative assessment and plan minimizes the risk of postoperative complications after blepharoplasty.

•Patient selection is critical to surgical outcome. It is important to avoid surgery on high-risk patients or those with unrealistic expectations.

•Identifying preoperative ocular or systemic conditions that can hinder surgical outcome is necessary to prevent postoperative adverse events.

•It is necessary to review the use of all systemic medications and anticoagulation risks with patients prior to surgery.

•The surgeon should create a plan for the amount of skin/ muscle/fat to be excised/preserved prior to proceeding with surgery.

•Detailed intraoperative measurements are important to achieve postoperative symmetry.

•Eyelid symmetry should be evaluated at various points of the procedure.

•Meticulous attention to homeostasis during surgery, and at the conclusion of the case, is essential.

•Wound closure should be performed under minimal tension.

•Be prepared to manage all potential postoperative complications, including those that you cannot prevent.

11.1Introduction

Blepharoplasty is one of the most common aesthetic cosmetic procedures performed. In 2009, the American Society for Aesthetic Plastic Surgery stated that it was the third most

J.A. Foster (*)

Associate Clinical Professor, Director, Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology,

Ohio State University, Columbus, OH, USA e-mail: fosterj@jillfoster.com

common cosmetic surgical procedure performed after breast augmentation and lipoplasty [1]. As the procedure is so common and performed by many different surgical subspecialties, it is important to recognize the potential complications and appropriate management techniques to effectively reduce the risk of adverse sequelae. There are multiple potential complications that may occur after upper blepharoplasty [2–5], ranging from self-limited annoyances to severe complications resulting in permanent loss of vision.

This chapter will discuss the complications that may occur in association with upper blepharoplasty. The appropriate medical management and surgical interventions will be reviewed for each potential complication.

11.2Complications

11.2.1 Hemorrhage

11.2.1.1 Eyelid Hematoma

An eyelid hematoma may occur during or after upper blepharoplasty and is commonly associated with anticoagulant therapy (Fig. 11.1), uncontrolled high blood pressure, trauma to the orbicularis muscle during surgery, and/or violation of the arcade vessels or deeper vasculature. Intraoperatively, visualization and cauterization of the tissues is imperative for hemostasis. Bleeding can lead to a collection of blood in tissue, which can be diffusely distributed (interstitial blood), or can manifest as a localized collection, or hematoma. It is important to distinguish between the two entities and treat each appropriately to avoid shortand long-term problems. Long-term side effects of eyelid hematomas can include fibrosis of the eyelid (malposition and/or decreased function) or pigmentary changes to the eyelid skin.

More importantly, if bleeding is extensive or progressive, it is important to assess for the presence of a retrobulbar hemorrhage by checking vision and pupillary reaction, testing retropulsion of the globe, measuring intraocular pressure,