Recovery and risks

First 24 hours

Most orbital hemorrhages occur within 3 hours of surgery and the risk drops after 24 hours, though bleeding can start days later. Vision loss symptoms peaked in the first hour and again at 6 to 12 hours, with pain and pressure the most common symptoms.[1][2]

Days 1 to 3

Lubricating ointment and cold compresses are applied, and the eyes may be loosely covered with gauze. One protocol uses ice packs for 3 days and antibiotic ointment on the incisions for 2 weeks.[1][2]

Week 1

Sutures are removed within one week. A transconjunctival incision usually heals within a week. Wound separation after upper blepharoplasty occurred in 1.4% of lids, at a mean of day 9.[1][2][3]

Days 10 to 14

Most patients are presentable in public in 10 to 14 days. After lower blepharoplasty, swelling lasted a mean 14 days, and 19 days when the orbicularis retaining ligament was released.[1][2]

Weeks 2 to 8

Chemosis, swelling of the conjunctiva, lasted a mean 26 days and a median 14 days, and all cases cleared within 180 days. Dry eye lasted more than 2 weeks in 10.9% of 202 patients and more than 2 months in 2%.[1][2]

Months and years

Final healing takes a few months. Sun protection and dark sunglasses are advised until healing is complete. Quality-of-life gains after ptosis repair held at 1.5 to 3.6 years.[1][2][3]

Orbital hemorrhage and vision loss

Orbital hemorrhage followed 0.055% of 269,433 cosmetic eyelid operations, about 1 in 2,000, and permanent vision loss 0.0045%, about 1 in 22,000. A survey of 752,816 blepharoplasties found permanent vision loss in 0.0033%, about 1 in 30,000, with hypertension the most common risk factor. In a review of 93 retrobulbar hematomas from all causes, 22% ended in blindness, and surgical decompression and faster treatment predicted recovery.[1][2][3]

Dry eye

In 892 cases, 26.5% reported dry eye symptoms after surgery, more after combined upper and lower surgery and skin-muscle flaps. In 202 patients, dry eye lasted beyond 2 months in 2%, and 1 patient needed surgery. A meta-analysis of 12 trials found upper blepharoplasty reduced dry eye symptoms overall.[1][2][3]

Ectropion and lower lid malposition

Across 30 studies of lower blepharoplasty, lid malposition ranged from 0% to 12% and ectropion from 0% to 11.3%. In one comparison, ligament release raised ectropion to 19.2% from 3.8%. ASPS lists ectropion and lid lag, which is often temporary.[1][2]

Chemosis

Chemosis followed 26.3% of 892 blepharoplasties and 15.6% of lower blepharoplasties alone. Canthopexy, combined upper and lower surgery, male sex and lid laxity raised the risk.[1][2]

Lagophthalmos and difficulty closing the eyes

Removing orbicularis muscle with skin in upper blepharoplasty raised the odds of lagophthalmos 7.98 times. Lagophthalmos after surgery raised the risk of dry eye. ASPS lists difficulty closing the eyes as a risk.[1][2][3]

Brow descent

After upper blepharoplasty alone, the brow dropped in 24 of 70 patients, 34.2%, and in 58.3% of men.[1]

Wound separation, scarring and infection

Wound separation followed 1.4% of 2,376 upper lids and was more common in men and with fast-absorbing gut suture. After lower blepharoplasty, infection ranged from 0% to 1.6% and unfavorable scarring from 0% to 12%.[1][2][3]

Revision

Reoperation after lower blepharoplasty ranged from 0% to 9% across 21 studies, and most reported less than 3%. ASPS notes another operation may be needed.[1][2]