Blepharoplasty is a common and generally well-tolerated operation, but like all surgery it carries risks. Bruising, swelling, temporary dry or watery eyes and blurred vision are common and usually settle. Less common risks include infection, asymmetry, a change in lower-lid position and difficulty closing the eyes fully; bleeding behind the eye is rare but needs immediate attention. Careful assessment and aftercare reduce these risks.
General surgical risks
- Bleeding: minor oozing is normal in the first day; a significant bleed under the skin can form a haematoma that may need draining.
- Infection: uncommon on the face because of its rich blood supply, and usually treated with antibiotics.
- Anaesthetic: upper blepharoplasty is often done under local anaesthetic, which avoids the risks of a general anaesthetic; if general anaesthesia is used, an anaesthetist assesses you beforehand.
- Blood clots (VTE): the risk is low for short eyelid procedures, especially under local anaesthetic, but it is assessed for everyone and walking soon after surgery helps.
Your medical history, medications and any supplements that affect bleeding are reviewed at consultation, and some may need to be paused before surgery.
Risks specific to eyelid surgery
- Dry or gritty eyes: common for a few weeks as the lids settle; lubricating drops help. People with pre-existing dry eye need particular care.
- Watering: the lower lid and tear drainage can be affected by swelling, usually temporarily.
- Asymmetry: the two eyes are never identical, and minor differences can persist after healing.
- Incomplete closure: the eyes may not close fully for a short time after upper-lid surgery; lasting problems are uncommon when skin removal is conservative.
- Lower-lid malposition: the lower lid can pull down (ectropion) or look rounded after lower blepharoplasty, particularly if the lid was lax beforehand.
- Hollowing: removing too much fat can leave a sunken look, which is why fat is often preserved or repositioned.
- Scarring and milia: tiny white cysts can appear along the scar and are easily treated.
The rare emergency: bleeding behind the eye
Very rarely, bleeding occurs deep in the eye socket after surgery (a retrobulbar haematoma). This causes increasing, severe pain, a tense, bulging eye and loss or blurring of vision, and it threatens eyesight if not treated immediately.
If you notice these signs, contact the surgical team straight away using the emergency number provided, or go to the nearest emergency department without delay. This is why patients are asked to rest, keep the head raised and avoid straining in the first days after surgery.
How risks are reduced
Careful selection is the most important safety step. Mr Nassab examines lid tone, tear production, brow position and any history of eye disease before planning surgery, and asks about previous eye procedures such as laser vision correction.
Conservative skin removal, preservation of fat where possible, and support of the lower lid when it is lax all help reduce complications. Stopping smoking, controlling blood pressure and following advice on medications also lower the risk of bleeding and poor healing.
What is normal, and what is a concern
Normal in the first two weeks: bruising that spreads and changes colour, puffiness worst in the morning, tightness, mild blurring from ointment, gritty or watery eyes, and slight differences between the sides.
Contact the team the same day for increasing redness, discharge, fever or pain that is getting worse rather than better. Seek urgent help for severe pain, a hard swollen eye or reduced vision. Sudden one-sided calf pain or leg swelling needs same-day assessment by your GP or NHS 111; chest pain or breathlessness means calling 999.
If a complication occurs
Most issues, such as milia, a slightly visible scar or temporary dryness, are minor and managed in clinic. A small number of patients benefit from a later adjustment once healing has finished, usually not before six months. Mr Nassab provides structured follow-up after surgery so that any concern is reviewed early, and explains the policy on further treatment at consultation. More detail on the operation itself is on the blepharoplasty page.
Frequently Asked Questions
Is blepharoplasty safe?
It is a well-established operation with a good safety record when performed by a qualified plastic surgeon, but every operation carries risk and these are discussed in full before you decide.
Can blepharoplasty damage eyesight?
Serious effects on vision are rare. The main threat is bleeding behind the eye, which needs immediate treatment, so knowing the warning signs matters.
How long does dry eye last after eyelid surgery?
Usually a few weeks. Lubricating drops and ointment help while the lids settle.
Why do the eyes look uneven after surgery?
Swelling often differs between sides in the early weeks. Final symmetry is judged after several months.
Who is at higher risk of complications?
Smokers, people with dry eye, thyroid eye disease, uncontrolled blood pressure or lax lower lids need extra planning, and surgery may not suit everyone.
