Complications of Blepharoplasty: A Comprehensive and Informative Guide

Blepharoplasty is one of the most commonly requested cosmetic surgery procedures in Mallorca for patients seeking to reduce excess eyelid skin, fatty bags, or the appearance of tired eyes. Like any surgical procedure, it is not without risks. Understanding the complications associated with blepharoplasty allows patients to make informed decisions with realistic expectations, assess indications and contraindications, and distinguish between what is part of the normal healing process and what requires medical follow-up.

This guide, prepared by Mallorca Medical Group based on the insights of Dr. García Ceballos, FCCP—a plastic surgeon trained at UZ VUB in Brussels—provides a thorough review of the most commonly reported complications, their prevention, and the role of individualized assessment. The information is for educational purposes only and is not a substitute for an in-person consultation.

What Are Complications Associated with Blepharoplasty?

In clinical practice, a complication is defined as an undesirable event that deviates from the expected recovery: hematoma, infection, altered eyelid closure, persistent asymmetry, significant dry eye, or, in select cases, ectropion or lagophthalmos. Not all swelling, bruising, or tightness felt in the first few days constitutes a complication: many of these symptoms are temporary and are anticipated in the postoperative care plan.

Plastic surgery in Mallorca treats the eyelid as a functional and aesthetic unit. The goal is not to “open up the eyes” aggressively, but rather to preserve eye protection, tear function, and periocular harmony. For this reason, the analysis of complications in blepharoplasty always begins with the indication: not all patients are candidates, and not all techniques (upper, lower, or combined; transcutaneous or transconjunctival) carry the same risk profile.

Most Common Complications and Their Clinical Context

The literature and daily practice agree on a set of relatively common events, most of which are mild and self-limiting when safety protocols are followed:

• More severe bruising or ecchymosis than expected, especially if the patient has uncontrolled hypertension or is taking medications that affect blood clotting.
• Chemosis (conjunctival edema) and temporary tearing.
• A sensation of dry eyes, photophobia, or a foreign body sensation in the first few weeks.
• Mild asymmetry in the fold or amount of residual skin, which sometimes improves as the edema subsides.
• Visible scarring or keloid formation, which is uncommon on the eyelid but possible in individuals with a tendency to form keloids.

Less common, though clinically significant, are retrobulbar hematoma (an emergency), infection, iatrogenic eyelid ptosis, lagophthalmos due to excessive skin resection, and lower eyelid ectropion. These complications in blepharoplasty can be prevented, to a large extent, by conservative resection, preservation of the orbicularis muscle, and an evaluation of canthal support prior to surgery.

Differences Between Upper and Lower Blepharoplasty

Upper blepharoplasty focuses on excess skin, the eyelid crease, and, when indicated, fat pockets. The most feared risk is leaving insufficient skin for eyelid closure, resulting in lagophthalmos and dryness. A preexisting, undiagnosed ptosis may also become apparent, or a drooping eyebrow that, if not addressed, makes the result appear incomplete.

In lower blepharoplasty, the situation is different. The lower eyelid is a more labile structure. Aggressive resection of skin or muscle—or failure to recognize canthal laxity—can lead to ectropion, a rounded canthus, and scleral exposure. For this reason, in patients with weak support, reinforcement procedures (canthopexy or cantoplasty) are considered, and in many cases, the transconjunctival approach is used to redistribute or reduce fat without leaving a skin scar. Each case is unique: there is no single technique that works for everyone.

Risk Factors and Prevention in Preoperative Evaluation

The prevention of complications in blepharoplasty is determined during the consultation, not in the operating room. Dr. García Ceballos, FCCP, emphasizes the importance of a complete medical history: dry eye, contact lens use, blepharitis, thyroid disease, hypertension, smoking, anticoagulant or antiplatelet therapy, and previous eyelid surgeries. The position of the eyebrow, the tone of the lower eyelid (distraction and snap-back tests), eyelid occlusion, and tear quality are also documented.

At Trusted Plastic Surgery Clinics in Spain, this evaluation is supplemented by medical photography and a written surgical plan. When the main issue is facial volume loss or sagging, a combined approach—for example, a facelift in Mallorca or fat grafting—may be more appropriate than performing blepharoplasty alone. Distinguishing between surgery and cosmetic medicine treatments in Mallorca (neuromodulators or periocular fillers) helps prevent the trivialization of injectables and reduces inappropriate indications.

“Safe blepharoplasty is not the procedure that removes the most skin, but rather the one that protects the eye and respects the anatomy of each eyelid. The best way to prevent complications is to say no when the indication is unclear.”

Dr. García Ceballos, FCCP

How to Address Complications When They Arise

Management is gradual and proportional. Superficial hematoma, edema, and dryness are treated with local cold therapy as indicated, ocular lubrication, eyelid hygiene, and scheduled follow-up visits. An expanding hematoma with severe pain, proptosis, or vision loss requires urgent evaluation. Mild ectropion may improve with massage, support strips, and time; if it persists, secondary correction (canthopexy, skin graft, or conservative revision) should be considered, but never immediately unless it is an emergency.

Reconstructive surgery in Mallorca plays a specific role here: to reconstruct support structures, replace skin, or correct asymmetry when function or occlusion is compromised. We do not promise a result identical to the original; rather, we aim for a proportionate improvement in both function and aesthetics. The cost of plastic surgery in Mallorca for a secondary revision is not comparable to that of a primary procedure and can only be estimated after evaluating the case.

Follow-up, Realistic Expectations, and When to Seek Medical Advice

Typical recovery involves bruising and swelling for one or two weeks, with the scar maturing over the course of several months. The final cosmetic result cannot be assessed in the first few days. You should seek immediate medical attention if you experience disproportionate pain, sudden blurred vision, an inability to close your eye, active bleeding, or worsening asymmetry. Any other concerns will be addressed during follow-up visits.

Those looking for the best plastic surgeons in Spain often value the transparency of the medical recommendation, informed consent, and accessible follow-up care. Reviews on www.mallorcamedicalgroup.com often highlight the provision of honest explanations of risks. Each patient is a unique case.

Complications from blepharoplasty are, for the most part, preventable or manageable when the technique is tailored to the specific eyelid and the patient understands the limitations of the procedure. A natural appearance, eye protection, and patient safety take precedence over any dramatic changes. If you are considering blepharoplasty or have questions about a previous eyelid surgery, request a personalized medical evaluation.

Book your consultation at mallorcamedicalgroup.com. Schedule an appointment with Mallorca Medical Group to discuss your medical history, the procedure, and a personalized surgical plan.

Dr. García Ceballos, FCCP
Plastic, Cosmetic, and Reconstructive Surgeon
Mallorca Medical Group · Palma de Mallorca

Frequently Asked Questions

Are complications from blepharoplasty common?

Most postoperative events are mild and transient (edema, bruising, dryness). Serious complications, such as retrobulbar hematoma or established ectropion, are rare when the indication and technique are appropriate. The risk is never zero and is discussed during the individualized assessment.

Can ectropion be prevented?

It is significantly reduced by assessing the laxity of the lower eyelid, avoiding excessive skin resections, and, if appropriate, combining the procedure with canthal reinforcement. Its complete absence cannot be guaranteed in all patients, especially if there is pre-existing laxity or a history of previous surgeries.

How long does it take to see the final results?

Bruises usually improve within one or two weeks, but residual swelling and scarring continue to resolve over the course of several months. Assessing the results too soon can lead to unrealistic expectations. The exact timeline depends on each individual case.

What should I do if I notice that my eye isn’t closing properly?

You should notify the medical team immediately. In the meantime, eye lubrication and protection of the eyeball are priorities. Transient lagophthalmos caused by edema is not the same as a skin deficiency; only a physical examination can distinguish between the two and determine whether observation is sufficient or whether correction is necessary.