What are the potential cosmetic long-term side effects?

While the goal of eyelid surgery is to improve appearance, errors in the surgical procedure can lead to long-term cosmetic issues that may require further surgery to correct.

Visible or disfiguring scarring

Some scarring is an unavoidable part of any surgical procedure. A skilled surgeon will place incisions within the natural eyelid crease of the upper lids or inside the lower eyelids (transconjunctival lower lid blepharoplasty) to minimise their visibility. However, negligence can lead to scarring that is more prominent than originally expected.

Signs of complications related to scarring include:

• Improper incision placement: scars located outside the natural creases, making them obvious.
• Poor wound closure: using an improper suturing technique or failing to close the wound correctly, leading to poor healing and a more prominent scar than would be reasonably expected.
• Infection: inadequate aftercare advice or failure to maintain sterile conditions can lead to infection at the surgical site, resulting in poor healing and scar abnormalities.

Asymmetry

The human face is naturally slightly asymmetrical. However, a blepharoplasty procedure should aim to create a balanced, symmetrical result. Significant asymmetry between the eyes post-surgery can be a sign of poor surgical planning or execution. This could manifest as uneven amounts of excess skin removed from the upper eyelids, or a difference in the shape and contour of the lower lids.

Altered eye shape and contour irregularities

A major risk of a poorly performed blepharoplasty is an unnatural change to the eye's shape. This can happen if the surgeon is overly aggressive and removes too much skin or fat.

• Hollowed appearance: excessive fat removal can leave the eyes looking hollow, sunken and older.
• Rounding of the eyelid: the natural almond shape of the eye can be lost, leading to a more rounded, "surprised" look, particularly affecting the lower eyelids.
• Skin contour irregularities: the delicate eyelid skin may develop bumps, palpable wrinkling or irregularities along the incision line due to improper healing or technique.

Persistent skin discolouration

While bruising is normal after eyelid surgery, some patients may experience long-term skin discoloration. The skin in or near the surgical site may become permanently lighter or darker than the surrounding skin. While rare, this can be a distressing long-term outcome.

What are the functional long-term side effects of blepharoplasty?

Beyond cosmetic concerns, negligent eyelid surgery can cause significant functional problems that affect vision and eye comfort, sometimes permanently.

Eyelid malposition (ectropion and retraction)

One of the most serious complications of lower eyelid blepharoplasty is eyelid malposition. This occurs when the lower eyelid is pulled down or turns outward, and is often a direct result of a surgeon removing too much eyelid skin or failing to properly support the deeper tissues of the lid.

• Lower lid retraction: the lower eyelid is pulled downwards, exposing the white part of the eye below the iris (known as scleral show).
• Ectropion: the lower eyelid turns outwards, exposing the inner surface.

Both conditions prevent the eyelid from protecting the eye's surface, leading to chronic dry eye, excessive tearing, irritation and an increased risk of corneal damage. These complications often require complex reconstructive surgery to correct.

Inability to close the eyes (lagophthalmos)

A similar issue that more commonly affects the upper eyelids is lagophthalmos, or the inability to close the eyes completely. This is a clear sign that too much skin was removed during the upper eyelid surgery. The constant exposure of the eye's surface can cause severe and persistent dry eyes, discomfort, and potentially lead to corneal ulcers and vision problems.

Chronic dry eyes

While temporary dry eyes are a common side effect as the area heals, long-term or chronic dry eye syndrome can be a debilitating complication. This can be caused by lagophthalmos, ectropion or damage to the tear-producing glands during the blepharoplasty procedure. The resulting lack of lubrication can cause a gritty sensation, redness, sensitivity to light and blurred vision.

Changes in vision

While temporary blurred vision is expected immediately after surgery, any permanent change is a serious complication.

• Double vision (diplopia): this can occur if the surgeon damages the delicate eye muscles that control eye movement during the procedure.
• Permanent vision impairment: in extremely rare cases, negligence during eyelid surgery can lead to vision loss. A deep orbital haemorrhage (bleeding behind the eye) can create pressure on the optic nerve. If a surgeon fails to recognise and treat this as an emergency, it can result in permanent blindness. This is a rare complication, but a catastrophic one.#

What are a surgeon's legal obligations for eyelid surgery?

Every surgical procedure carries inherent risks, and an unsatisfactory outcome is not automatically proof of negligence. For a claim to be successful, it must be proven that the surgeon breached their duty of care, and this breach directly caused your injury.

A surgeon's duty of care includes:

1. Prior to surgery: fully informing you of all risks and complications, discussing realistic outcomes and properly assessing your suitability for the cosmetic procedure.
2. During surgery: performing the blepharoplasty surgery to the standard of a reasonably competent plastic surgeon or oculoplastic surgeon, using correct techniques and avoiding the removal of excess skin or fat.
3. After surgery: providing clear aftercare instructions and properly monitoring your healing process to identify and address any complications, like infection, in a timely manner.

If you have suffered long-term complications following eyelid surgery, and you believe your surgeon failed in their duty of care, you may be entitled to make a claim for compensation.

How many times can blepharoplasty be performed?

There is no strict limit on the number of times a person can have eyelid surgery, but repeat procedures are generally not recommended and carry increased risks. Revision blepharoplasty may be necessary to correct an unsatisfactory result from a previous surgery or due to the continued natural ageing process.

However, each subsequent surgical procedure is more complex than the last. Scar tissue from the initial surgery alters the natural anatomy, making it more challenging for the surgeon. The risks of complications like scarring, dry eyes and eyelid malposition are higher with revision surgery. It is therefore essential to choose a highly specialised oculoplastic surgeon for any repeat blepharoplasty procedure.