Patients with known or undocumented preexisting psychological disorders may respond inappropriately to a normal healing process and final result after blepharoplasty. This topic is covered in Chapter 39.
Here we present a brief look at postoperative disappointments and difficulties that sometimes arise in perfectly well-adjusted people who failed to be educated by the surgeon (or to educate themselves) about the nature of cosmetic eyelid surgery until after the fact.
• Unrealistic expectations: If you are expecting "perfection" from your surgery, be warned that you are all but certain to be disappointed. It is important, therefore, to understand exactly what you should and should NOT anticipate from any given cosmetic eyelid surgery. If your expectations are inappropriate or inflated because of your lack of preparation or your surgeon's lack of explanation, no matter how wonderful the result may be from an objective point of view, you will not be satisfied. So you should understand going into it that perfection is never attained because no surgeon is perfect, no wound will heal perfectly, and most patients possess some anatomic limitations. If you can't accept this concept, you should not undergo cosmetic surgery.
• Patient indecision: Some patients (generally, those inordinately afraid of being overcorrected) make a definite point of requesting a very conservative approach ("I just want to look a tad better.") only to be disappointed by the expected undercorrection. This is not the fault of the surgery or the surgeon, who was following a specific request. While more surgery can usually be undertaken, such patients should be fully prepared to pay for the second operation.
• Poor aesthetic choice: Not often mentioned in lists of blepharoplasty "complications" is the matter of inappropriate selection of procedure or poor aesthetic judgment on the part of the surgeon resulting in "technical" success but cosmetic "failure". For instance, if what you really need is an upper blepharoplasty but what you have done instead is a forehead lift, you may still be very unhappy about the way you look even though the forehead lift was performed skillfully. As with unrealistic expectations, the best (and only) approach is avoidance. Be sure you and your surgeon understand and agree upon exactly what you are getting yourself into ahead of time because the results from inappropriate surgery are often hard or impossible to reverse.