Safety Considerations in Blepharoplasty: A Comprehensive Review

Blepharoplasty is one of the most frequently performed aesthetic facial procedures worldwide. It is widely regarded as safe when performed with appropriate surgical planning and technique. Nevertheless, the complexity of eyelids makes periocular surgery uniquely sensitive to technical errors and potential postoperative untoward sequelae. This review summarizes contemporary safety considerations in cosmetic blepharoplasty. We will focus on reported complication patterns, patient- and procedure-related risk factors, and strategies for prevention, recognition, and management. Due to heterogeneity in surgical techniques and study design, findings were synthesized qualitatively. Complication incidence ranges were reported descriptively. Reported complications ranged from common, which comprised typically self-limited ocular surface disturbances, to structural eyelid abnormalities. The latter includes retraction, scleral show, ectropion, and postoperative ptosis. Rare but serious complications, including orbital hemorrhage, diplopia, infection, and vision loss, have also been reported. Across studies, important determinants of safety included preexisting ocular surface disease, prior periocular surgery, eyelid laxity, negative vector anatomy, globe prominence, anticoagulant use, surgical approach, extent of anterior lamellar excision, fat manipulation, and the use of adjunctive canthal support procedures. Although most complications are minor and transient, a structured approach emphasizing careful patient selection, conservative tissue handling, meticulous hemostasis, and early recognition of postoperative abnormalities is essential to minimize morbidity and optimize functional and aesthetic outcomes.