Unfavorable Results after Cosmetic Blepharoplasty—A Study of 41 Patients

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Introduction: The purpose of this study is to elucidate the various types of unfavorable results after cosmetic blepharoplasty and adjunctive mid–face-lift and their management by an oculoplastic surgeon specializing in cosmetic eyelid surgery. Materials and Methods: The charts of patients who had unfavorable results after cosmetic eyelid surgery in the 3-year period ending October 31, 2002, were retrospectively reviewed. An unfavorable result after cosmetic blepharoplasty was defined by a (a) need for functional revisional surgery or (b) request from the patient for cosmetic revision. Results: Review of over 300 charts from the author revealed 41 patients who met criteria for inclusion in the study. Twenty-one patients had functional problems that required additional surgery and 13 patients sought further corrective surgery for cosmetic problems. Seven patients had complications that did not warrant further surgery, including dry eye, ectropion, or lagophthalmos. In these patients, the problem gradually resolved or required topical lubrication. The most common problem was lower eyelid retraction, which occurred in 10 patients and required functional repair in 9. Discussion: Canthopexy or lower eyelid shortening helps present lower lid retraction after cosmetic lower blepharoplasty and is advisable is virtually all cases. However, canthopexy alone does not present lower lid retraction especially when mid–face-lifts are concomitantly performed. Surgeons should strive for symmetrical results because patients who request cosmetic repair notice asymmetry. Transient dry eye and conjunctival Chemosis due to exposure keratitis with or without accompanying significant malposition often resolves with conservative treatment. Preoperative ophthalmologic consultation may help determine patients who are predisposed to symptoms of dry eye after cosmetic blepharoplasty. An unfavorable result may necessitate early repair when the ocular function is compromised. The author concludes that most patients are satisfied and happy with a more modest improvement after cosmetic blepharoplasty that is achieved without a complication.