What is eyelid surgery (blepharoplasty)?

Blepharoplasty is a surgical procedure designed to improve the appearance of the eyelids. It can be performed on the upper eyelids, the lower eyelids, or both. The surgery may involve the removal or repositioning of excess tissue, including excess skin, muscle and fat.

People choose to have this cosmetic procedure for various reasons:

• Upper blepharoplasty: this procedure is often performed to remove excess eyelid skin that creates a "hooded appearance" or sagging skin over the eyelid crease. In some cases, this excess skin can even impair peripheral vision. The surgeon makes an incision in the natural crease of the upper eyelid to remove excess skin and sometimes a small amount of fat before closing the incision.
• Lower eyelid surgery: this surgery targets eye bags and puffiness under the eyes. An incision is typically made just below the lower lash line or on the inside of the lower eyelid. The surgeon then removes or repositions excess fat and may remove a small amount of skin to create a smoother contour.

While it is a common plastic surgery, it is vital to remember that it is a delicate and complex procedure that requires a skilled and qualified surgeon. Your surgeon should outline the full details about the surgery including what can go wrong with lower eyelid surgery and upper eyelid surgery, the expected aftercare and alternatives to the surgery.

What can go wrong with eyelid surgery?

Like any surgical procedure, blepharoplasty carries recognised risks. While upper and lower eyelid surgery is generally safe when performed by an experienced surgeon, complications can occur. It is important to distinguish between normal, temporary side effects associated with healing and more serious issues that may suggest a problem with the procedure itself.

Understanding what is expected during recovery - and what is not - can help you recognise when medical advice should be sought.

Common and temporary side effects

Following blepharoplasty surgery, your body will go through a natural healing process. During this time, certain symptoms are entirely normal and usually resolve within days or weeks.

• Bruising and swelling: this is the most common side effect. Significant bruising and swelling around the surgical site are expected and typically peak within the first 48 hours. Swelling gradually subsides over 7 to 14 days, although minor puffiness can persist slightly longer.
• Dry or irritated eyes: temporary dryness, a gritty sensation or mild irritation are frequently reported after eyelid surgery. Lubricating eye drops are often recommended to ease discomfort. In most cases, these symptoms resolve within several weeks as the eyelids recover.
• Blurred vision: temporary blurred or double vision may occur in the initial days following surgery. This is often due to swelling or the lubricating ointment used during the procedure. Vision should stabilise as swelling reduces.
• Discomfort and numbness: mild pain, tenderness or tightness is expected and can usually be managed with prescribed medication. Temporary numbness of the eyelid skin is also common, as small nerve endings take time to heal. Sensation typically returns gradually.
• Light sensitivity and watery eyes: increased sensitivity to light and excessive tearing are normal during early recovery. Wearing sunglasses outdoors can help manage these temporary symptoms.

More serious blepharoplasty complications

Although less common, some complications can have longer-term functional or aesthetic consequences. These may require corrective treatment and, in certain cases, further surgical intervention.

• Eyelid malposition:
  Surgery can sometimes alter the natural position of the eyelid. This may include:

Ptosis: drooping of the upper eyelid.

Retraction: where the lower lid is pulled downward, exposing too much of the white of the eye.

Ectropion: where the lower eyelid turns outwards.

These issues can affect both appearance and eye comfort.

• Inability to close the eyes (lagophthalmos): this is a serious complication that can occur if too much skin is removed from the upper eyelids. Incomplete eyelid closure can lead to severe dryness, irritation, corneal damage and potential vision problems if not addressed promptly.
• Asymmetry: while natural facial asymmetry is common, noticeable differences between the two eyes after swelling has settled may indicate a poor surgical outcome or uneven tissue removal.
• Unfavourable scarring: blepharoplasty incisions are typically placed within natural creases to minimise visibility. However, in some cases, poor healing may result in thickened, raised or visible scars that affect the overall aesthetic result.
• Infection: although uncommon with appropriate surgical technique and postoperative care, infection can occur. Signs may include increasing redness, warmth, discharge or worsening pain at the incision site. Prompt treatment is essential to prevent further complications.
• Vision problems: in very rare cases, severe complications such as a retrobulbar haemorrhage (bleeding behind the eye) can increase pressure within the eye socket and damage the optic nerve. This is a medical emergency and can potentially lead to permanent vision loss if not treated immediately. Damage to the eye muscles during surgery may also result in persistent double vision.
• Skin discolouration: permanent changes in the colour or pigmentation of the eyelid skin can occasionally occur, particularly if healing is complicated.

While most people recover from blepharoplasty without significant issues, it is important to monitor your symptoms carefully. If swelling worsens rather than improves, if you experience increasing pain, difficulty closing your eyes or any change in vision, seeking urgent medical advice is essential. Early intervention can significantly reduce the risk of long-term complications.

What are the signs of a poor blepharoplasty outcome?

A poor blepharoplasty outcome is one that results in functional problems, an undesirable aesthetic appearance, or both. While no surgical result is ever perfectly symmetrical or identical to expectations, certain signs may indicate that the procedure has not been carried out to an appropriate standard. These issues can range from subtle contour irregularities to more significant complications that affect both appearance and eye function.

A hollowed or sunken appearance

The removal of too much excess fat from the upper or lower eyelids can create a hollowed, gaunt or skeletal look. Rather than achieving a refreshed appearance, this can make a person look older, fatigued or unwell. Over-resection of fat is difficult to reverse and may require complex corrective procedures.

Unnatural shape or contour

The eyes may appear rounded, overly tight, surprised or noticeably “operated on”. This can occur if the natural almond shape of the eye is altered or if the skin surface heals unevenly, leading to contour irregularities. A well-performed blepharoplasty should enhance natural features, not distort them.

Lower eyelid retraction (scleral show)

A classic sign of a poorly performed lower blepharoplasty is lower lid retraction, sometimes referred to as scleral show. This occurs when the lower eyelid is pulled downward, exposing the white part of the eye beneath the iris. In addition to creating an unnatural or strained appearance, it can lead to chronic dryness, irritation and watering due to improper eyelid closure.

Persistent drooping eyelids (ptosis)

If upper eyelid surgery fails to correct drooping eyelids - or, in some cases, worsens the condition - this may indicate an unsatisfactory result. Ptosis can occur if the muscle responsible for lifting the eyelid is damaged, not properly assessed before surgery, or inadequately addressed during the procedure. This can affect both appearance and vision.

Difficulty closing the eyes

One of the most serious functional concerns following blepharoplasty is the inability to close the eyes fully, known as lagophthalmos. This may occur if too much skin is removed from the upper eyelids. Incomplete eyelid closure can lead to severe dryness, exposure of the cornea, irritation and, in more serious cases, damage to vision. This complication requires prompt medical attention.

Can an unsuccessful blepharoplasty be fixed?

In many cases, complications or unsatisfactory results from a previous blepharoplasty can be improved through a highly specialised procedure known as revision blepharoplasty. However, corrective surgery is significantly more complex than the original operation and must be approached with great care.

Revision blepharoplasty should only be performed by a surgeon who is specifically experienced in secondary or revision eyelid surgery, not simply primary cosmetic procedures. The presence of scar tissue, altered anatomy and reduced tissue availability makes these cases technically demanding. A surgeon undertaking corrective work must have an advanced understanding of eyelid anatomy, functional mechanics and reconstructive techniques.

It is essential to choose a surgeon who is:

• Extensively experienced in revision blepharoplasty
• Skilled in complex eyelid reconstruction
• Properly registered with the General Medical Council
• Able to demonstrate a clear track record in secondary eyelid procedures

Most surgeons will advise waiting at least six to twelve months after the original surgery before considering revision. This allows swelling to fully settle, scar tissue to mature, and the final outcome of the initial procedure to be properly assessed.

How can blepharoplasty go wrong after lower eyelid surgery

Lower eyelid surgery carries its own unique set of risks. The most common complication associated with lower blepharoplasty is lower eyelid malposition, specifically retraction or ectropion. This risk is higher when an incision is made through the skin on the outside of the eyelid (a transcutaneous approach).

The delicate support structures of the lower lid can be weakened during surgery, causing it to sag or pull away from the eye. This can lead to significant discomfort and may require an additional, complex corrective procedure. For this reason, many surgeons now favour techniques that avoid a skin incision or provide extra support to the lower eyelid to minimise this risk.

When do eyelid surgery problems become negligence?

Experiencing a complication after cosmetic surgery does not automatically mean negligence has occurred. Every surgical procedure has known risks, and sometimes poor outcomes happen even when the highest standards of care are met.

However, negligence occurs when a surgeon’s care falls below the standard reasonably expected of a competent professional in their field, and this breach of duty directly causes you harm.

Signs of potential negligence in blepharoplasty can include:

• Failure to inform of risks: your surgeon has a duty to explain all the common problems with blepharoplasty and associated risks of the procedure, allowing you to provide informed consent.
• Incorrect surgical technique: errors such as removing too much skin from the upper eyelids, causing an inability to close the eyes, or aggressively removing fat leading to a hollowed appearance, can be considered a breach of duty.

Inadequate assessment: a failure to consider a patient’s medical history, such as pre-existing dry eye or thyroid eye disease, or failing to recognise a low brow position which should be addressed with a brow lift, can lead to poor outcomes.

• Poor postoperative care: a failure to recognise and appropriately manage complications like infection or bleeding after the surgery can also constitute negligence.

If you believe your surgeon failed in their duty of care, causing you avoidable harm, you may be able to make a claim for compensation.

What can blepharoplasty negligence compensation cover?

The purpose of compensation in a blepharoplasty negligence claim is to help restore you, as far as possible, to the position you would have been in had the negligence not occurred. While compensation cannot undo the physical and emotional impact of an unsuccessful eyelid procedure, it can provide the practical and financial support needed to access corrective treatment and move forward with confidence.

Each claim is assessed individually, taking into account the severity of the harm, the long-term effects on your wellbeing and the wider impact on your daily life. Depending on your circumstances, compensation can typically cover:

• Corrective surgery: the cost of revision blepharoplasty or further procedures required to address functional or aesthetic damage caused by negligent treatment, including specialist consultations and follow-up care.
• Loss of earnings: where you have been unable to work during an extended recovery period, or where complications have delayed your return to employment or affected your ability to carry out your role.
• Medical expenses: costs associated with additional medical treatment, including prescription medications, prescribed eye drops, specialist assessments and ongoing clinical care.
• Psychological support: the emotional impact of a negative cosmetic surgery outcome can be significant. Compensation can include the cost of counselling or therapy where you have experienced anxiety, reduced confidence or distress as a result of the procedure.
• Pain and suffering: an award to reflect the physical discomfort, ongoing symptoms and emotional distress you have experienced due to the negligent surgery.

In some cases, compensation may also account for future treatment needs if long-term complications require continued medical support. At Cosmetic Surgery Solicitors, we work closely with independent medical experts to ensure your claim accurately reflects the full extent of what you have experienced, so that you can access the support and treatment necessary to rebuild your confidence and wellbeing.

How long do you have to make a claim?

In most blepharoplasty negligence claims, you have three years to begin legal proceedings. This time limit is set by the Limitation Act 1980 and is strictly applied by the courts.

The three-year period usually starts from:

• The date of the surgery, if you were immediately aware that something had gone wrong, or
• The “date of knowledge”, which is the date you first became aware (or could reasonably have become aware) that your injury or complications may have been caused by negligent treatment.

In cosmetic surgery cases, it is not uncommon for the date of knowledge to arise later - for example, when complications persist beyond the expected healing period, when a second medical opinion identifies substandard treatment or when the long-term impact of the procedure becomes clear.

Because time limits can be complex - and because evidence is easier to secure when action is taken promptly - it is important to seek specialist legal advice as soon as you suspect negligence. Acting early helps protect your right to pursue compensation and allows your solicitor to begin gathering medical records and expert evidence without delay.