Functional Deformities
The most common functional deformities are inability to completely close the upper eyelids, lagopthtalmos, and pulling down of the lower eyelids, lid retraction. Lagophthalmos can be caused by a shortage of skin in the upper eyelids from excessive removal of tissue or from internal scarring of the posterior lamella which prevents the lid from closing all the way. Lid retraction of the lower lid can range from scleral show to ectropion. Ectropion, severe turning out of the lower lid, also contributes to lagopthalmos. Both lagophthalmos and ectropion allow air to get to the eye causing discomfort from dryness to the cornea. If left untreated, corneal dryness can progress to ulceration of the cornea which can significantly impair vision. Temporary treatment until surgical correction can be performed includes the liberal use of eyedrops and ointment throughout the day and patching at night. In addition, a suture can be placed to close the outer corner of the eyelids called a temporary tarsorrhaphy. Consideration should be given to the timing of surgery based on the severity of the deformity.

Cosmetic Deformities
Cosmetic deformities can range from dissatisfaction with the result due to minimal improvement to severe scarring or contour irregularities. Conservative removal of tissue may result in a residual fold in the outer part of the upper eyelid which is not a true complication but does require minor surgical revision. Overresection of fat from the periorbital fat pads can cause an uneven upper lid crease called an A-frame deformity which can be corrected with fat grafting. An upper lid scar which is not hidden in the crease can be improved with a crease procedure to move the scar into the crease. A droopy upper lid can occur after blepharoplasty and is called post-blepharoplasty ptosis. This requires correction of ptosis with tarsolevator advancement and may be considered a functional deformity if the upper visual field is blocked. Cosmetic deformities of the lower lid include a change in the shape of the eyelid which makes the patient feel that their eyes no longer look like they did before surgery. Correction of eye shape can generally be achieved with lateral canthoplasty. Residual loose skin may require additional tightening and persistent puffiness may require additional fat removal. A hollow appearance underneath the eyelids after surgery may be caused by overresection of periorbital fat. This may be corrected with fat grafting or a midface lift. Excessive scarring may be treated with steroid injection, laser treatments or scar revision.

What Are The Most Common Complications?
The most common complications following blepharoplasty are a change in the shape of the eye from an almond shape to a round appearance.Ectropion of the lower lid may occur which causes the lower lid to roll outward resulting in an uncomfortable feeling of dryness. There are a number of surgical techniques which may be required if conservative management with massage, taping the eyelid up, and eyedrops does not improve the situation.

How can these complications be corrected?
Depending on the specific complication, there a several techniques which can improve or restore the shape of the eyelid. Fixation of the corner of the eyelid to the bone with a lateral canthoplasty is often required. The lateral canthoplasty may be further supported with a periosteal flap or a tiny drill hole into the bone for secure fixation. A spacer graft, which is placed under the lid deep to the skin to help hole the lid up, is also commonly required. The options for these spacer grafts are commonly Alloderm, ear cartilage, dermis fat grafts or Medpor. Skin grafting is rarely required unless there is significant skin shortage. Dr. Codner will review which option is most appropriate on a case-by-case basis.