What looks good today should also look tomorrow and for many more tomorrows to come. Nobody likes late surprises.
Most problems after blepharoplasty surgery become apparent in the immediate post-operative period, but there are at least three notable exceptions:
(1) Eyelid Hollowness - As aging progresses, some people naturally "absorb" a substantial amount of the fat from the inside of their eye sockets. If surgical fat removal or excessive manipulation has been undertaken in such a patient at an earlier age, the orbit may hollow and come to look gradually more skeletal as the years pass.
A small amount of fat atrophy likely occurs in almost every patient. Predicting which patients are most prone to more than a little progressive loss is difficult although looking at older members in the family may provide a clue.
Conservative or even no fat removal as well as intraoperative minimal manipulation of fat are prudent preventatives.
Late hollowing & collapse after
transconjunctival lower blepharoplasty
(2) Lower Eyelid Retraction or Collapse - A skin approach (transcutaneous approach) to the deeper structures of the lower eyelid undertaken for any reason (e.g., blepharoplasty, midface lift, fat transfer, etc.) may cause increased internal scarring during healing. Over years, the stress from such tightening coupled with the weakening of anatomic supporting structure may cause failure of the eyelid's support system with the eventual development of noticeable eyelid retraction. Even the minimally-invasive transconjunctival approach to lower fat thinning (photo above) may lead to late surprises.
(3) Dry Eyes - Distribution of tears across the eye's surface is not a gravity-generated passive activity but rather a complex action directed by a number of anatomic structures in the eyelids. The "lacrimal pump" is the name for this mechanism, which requires normal orbicularis muscle power, normal positioning of the lower eyelid margin against the eyeball, and normal functioning of the medial canthal tendon nearest the nose. All of these processes and structures may be damaged during aggressive upper and/or lower blepharoplasty. Decreased tear production and weakening of this intricately dynamic mechanism occurs naturally with aging. Add to this additional damage from overly aggressive or poorly selected blepharoplasty procedures performed years earlier and the net result can be annoying or even dangerous tear system and eye health malfunction: eyes that are too dry, too wet, and/ or too exposed.
Recognition of long-term problems such as these has led to the development of newer "tissue-sparing" approaches for both upper and lower blepharoplasty.