What is blepharoplasty surgery?

Blepharoplasty surgery is a cosmetic procedure designed to reshape the upper and lower eyelids by removing or repositioning skin, muscle, or fat. It is often recommended to address issues such as droopy eyelids, sagging upper eyelids, and sagging skin that can develop around the eyes with age. In more advanced cases, droopy upper eyelids may obstruct the field of vision, turning what is often seen as a cosmetic procedure into a functional necessity.

Upper eyelid surgery - also referred to as upper blepharoplasty - focuses on correcting age-related changes by precisely targeting excess eyelid skin and excess fat that can build up in the delicate tissues around the eyes. These changes often occur as part of the natural ageing process but may also be influenced by inherited eyelid anatomy. Left unaddressed, this excess tissue can weigh down the eyelids, leading to a tired or heavy-eyed appearance.

Blepharoplasty may be performed on the upper and lower eyelids separately or together, depending on the individual’s needs. When carried out on both areas, it aims to remove excess skin, reposition or reduce excess fat, and refine the contour of the eyes for a more open, rejuvenated look. The procedure is carefully tailored to each individual, whether the goal is aesthetic enhancement, functional improvement or both.

The surgery is usually undertaken by a consultant plastic surgeon or a specialist oculoplastic surgeon, who has advanced training in the complex anatomy and function of the eyelids. Their expertise ensures that both the cosmetic outcome and the functional health of the eyes are prioritised throughout the treatment process.

How safe is blepharoplasty and what are the potential side effects?

Every surgical procedure carries potential risks and side effects, and eyelid surgery is no exception. While blepharoplasty is generally considered safe when performed by a qualified surgeon, it is important to understand that all forms of surgery involve some degree of uncertainty. Common side effects such as bruising, swelling, and temporary blurred vision are a normal part of the healing process. These should improve in the days and weeks following your procedure.

Other eyelid surgery risks include:

• Scarring: you can expect scars from the surgery. These will usually be quite red and prominent at first, but they should eventually fade over time. Scarring should be as your surgeon described prior to surgery, with regards to location and appearance.
• Bleeding: although rare, bleeding is possible and can range from a mild inconvenience to an emergency. You may need additional treatment or surgery to stop the bleeding. If there is bleeding into your eye socket, you should contact a doctor at once, as the increased pressure in the eye socket can cause blindness. A build-up of clotted blood underneath the surgery site can delay the healing process or cause additional scarring, and you may need another operation to remove this.
• Swelling, pain or bruising: there will be some bruising and swelling around the eyes after the surgery, and this can take several weeks to settle. There may be some long-term pain, but this is uncommon.
• Infection: if the wound becomes infected, you may need another operation or a course of antibiotics. This can affect the final result of the operation.
• Healing problems: sometimes, wounds may take longer than expected to heal. This problem is usually fixed by dressing the wounds but in extreme cases, you may need a further operation to remove the unhealed tissue. Smokers are more likely to have problems with healing.
• Asymmetry: sometimes, the eyes may not be symmetrical after the surgery. Most people have a degree of asymmetry in the eyes. However, the surgery may make this more noticeable.
• Eyelid position problems: for the first couple of days after the surgery, the eyelash line of the lower lid may be slightly pushed away from the eye because of the swelling. This will usually settle down on its own. However, some people require a further operation to fix this issue. If too much skin has been removed, this can cause your eyelid to become so tight that it can't close properly, a condition called lagophthalmos. This can lead to dryness of the eye, and you may need a small skin graft to fix this problem.
• Damage to deeper structures: on rare occasions, surgery can damage deeper structures than fat, such as the nerves, eyes, blood vessels or muscles. This damage may be temporary or permanent. In extremely rare cases, blindness may occur.

It is important to remember that experiencing one of these complications does not automatically mean negligence has occurred. However, a surgeon’s failure to manage them correctly or mistakes made during the procedure can be grounds for a claim.

When does a poor outcome become medical negligence?

For a blepharoplasty to be considered negligent, it must be proven that the surgeon or medical team failed to meet the expected standard of care, directly causing you harm. This legal obligation, known as the "duty of care," applies before, during and after your eyelid surgery.

Failures before surgery:

• Failure to obtain informed consent: you must be made fully aware of all the potential risks, benefits and alternatives to the blepharoplasty procedure. If a surgeon downplays risks or fails to mention a serious potential complication that later occurs, this may be a breach of duty.
• Inadequate patient assessment: a surgeon must take a thorough medical history to determine if you are a suitable candidate. Proceeding with eyelid surgery on a patient with known contraindications, such as severe dry eyes, uncontrolled high blood pressure, or thyroid eye disease, without proper precautions could be deemed negligent.

Failures after surgery:

• Providing clear aftercare instructions: failure to advise on proper wound care, activity restrictions, and when to use prescribed eye drops can lead to infection or poor healing.
• Failing to recognise and treat complications: if you report signs of infection, excessive bleeding, or severe pain, a surgeon has a duty to investigate and act promptly. Ignoring these signs could worsen the injury and constitute negligence.

If you believe your surgeon failed in their duty of care at any of these stages, and this resulted in injury, you may be entitled to compensation.

Are some people at higher risk for eyelid surgery complications?

Certain pre-existing conditions can increase the risks associated with a blepharoplasty procedure. A responsible and qualified surgeon has a duty to thoroughly assess a patient’s overall health, medical history and suitability for upper or lower eyelid surgery before proceeding.

Medical conditions that increase risk include:

• Eye conditions: glaucoma, a detached retina and especially chronic dry eye syndrome can be worsened by eyelid surgery, potentially leading to discomfort or impaired vision if not properly managed.
• Thyroid disorders: conditions such as Graves' disease (also known as thyroid eye disease) can alter the structure and function of the eyes and eyelids, making surgery more complex and risk-prone.
• Systemic health issues: uncontrolled diabetes can slow wound healing and increase the chance of infection, while high blood pressure can raise the risk of bleeding. Other conditions such as cardiovascular disease and blood clotting disorders must also be carefully considered.
• Smoking: smoking reduces blood flow and oxygen delivery to healing tissues, significantly increasing the risk of poor scarring, delayed recovery and infection.

If a surgeon fails to recognise or properly respond to these risk factors, patients may be exposed to preventable complications. In such cases, you may be entitled to make a compensation claim. Our team can help you determine whether your care met the expected medical standards.