[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Ophthalmology](https://durgical.com/en/ophthalmology/) › [Eye surgery and procedures](https://durgical.com/en/ophthalmology/areas/surgery/) › Eyelid and brow surgery: blepharoplasty and brow ptosis # Eyelid and brow surgery: blepharoplasty and brow ptosis - Topic Blepharoplasty removes excess lid skin and fat. A rare, blinding risk is bleeding behind the eye: pain, a bulging eye and vision loss need action within hours. Updated Nov 13, 2026 **See it in 3D:** [Eyelids](https://durgical.com/en/anatomy/superior-tarsus/) · [Orbicularis oculi](https://durgical.com/en/anatomy/orbital-part-of-orbicularis-oculi/) · [Levator palpebrae](https://durgical.com/en/anatomy/levator-palpebrae-superioris/) · [Frontalis](https://durgical.com/en/anatomy/occipitofrontalis-muscle/) ## Key points - Dermatochalasis is not ptosis, and neither is brow ptosis. - Retrobulbar haemorrhage: pain, proptosis, vision loss. - Treatment: lateral canthotomy and cantholysis, within hours. - Dry eye and incomplete closure after surgery. - Lower-lid surgery: retraction and ectropion. ## What it is With age, excess upper-lid skin (dermatochalasis) and a descending brow can hang over the lashes and block the upper field of vision. Upper blepharoplasty removes skin and sometimes fat; lower blepharoplasty, through the skin or the conjunctiva, treats lower-lid bags; a brow lift corrects brow ptosis. These must be told apart from true ptosis (a weak or detached levator), which needs a different operation. Complications include dry eye, incomplete closure, lower-lid retraction, asymmetry and, rarely, retrobulbar haemorrhage. ## Key facts - Surgery is functional when skin rests on the lashes and narrows the upper field; fields are often compared with the lids taped up and down. - Tell apart dermatochalasis (excess skin), brow ptosis (low brow) and true ptosis (low lid margin, measured by the margin-to-reflex distance and levator function). - Before surgery, look for dry eye, incomplete lid closure, thyroid eye disease, earlier refractive surgery and anticoagulant or antiplatelet use. - Retrobulbar haemorrhage usually appears in the first day: severe pain, proptosis, a tense orbit, falling vision and a relative afferent pupillary defect. - Lower-lid surgery can pull the lid down (retraction or ectropion), exposing the cornea. ## In clinical practice - Retrobulbar haemorrhage is an orbital compartment syndrome: the retina tolerates the pressure only for a short time, so lateral canthotomy and cantholysis are done within about two hours. - Anticoagulants and antiplatelet drugs are planned with the prescriber and the surgeon; they are never stopped without a plan. - Incomplete closure after surgery dries the cornea (exposure keratopathy); lubricants and review are needed. - A droopy lid can be the sign of myasthenia, Horner syndrome or a third nerve palsy, which cosmetic surgery would hide. ## Next step / Initial management - Pain, a bulging eye, tight lids or loss of vision after lid surgery: emergency; if vision is threatened, lateral canthotomy and cantholysis without waiting for imaging, and call ophthalmology. - Before referring for blepharoplasty: record acuity, fields and dry eye, and whether the skin blocks vision. - Lid droop that varies with fatigue, with unequal pupils or with limited eye movements: investigate myasthenia, Horner syndrome or a third nerve palsy instead of cosmetic surgery. - Patients on anticoagulants or antiplatelets: plan with the prescriber and the surgeon before surgery. - Dry, gritty eye with incomplete closure after surgery: lubricants and review by the surgeon. ## Test yourself Think of the answer, then tap the question to see it. ## Hours after a blepharoplasty, a patient has severe pain, a bulging eye and falling vision. What is it and what is done? A retrobulbar haemorrhage (orbital compartment syndrome); urgent lateral canthotomy and cantholysis. ## How is dermatochalasis told apart from true ptosis? In dermatochalasis the lid margin is in a normal position and excess skin hangs over it; in ptosis the margin itself is low, with a reduced margin-to-reflex distance. ## Which complication is typical of lower-lid blepharoplasty? Lower-lid retraction or ectropion, which can expose the cornea. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/ophthalmology/eyelid-and-brow-surgery-blepharoplasty-and-brow-ptosis/) ## Connections ## See it in 3D 4 The structures of Durgical's 3D anatomy where it is found. - [Eyelids](https://durgical.com/en/anatomy/superior-tarsus/) - [Orbicularis oculi](https://durgical.com/en/anatomy/orbital-part-of-orbicularis-oculi/) - [Levator palpebrae](https://durgical.com/en/anatomy/levator-palpebrae-superioris/) - [Frontalis](https://durgical.com/en/anatomy/occipitofrontalis-muscle/) ## Related 4 - [Orbital compartment syndrome and lateral canthotomy](https://durgical.com/en/ophthalmology/orbital-compartment-syndrome-and-lateral-canthotomy/) - [Drooping eyelid (ptosis)](https://durgical.com/en/ophthalmology/drooping-eyelid/) - [The orbit, orbital septum and eyelids](https://durgical.com/en/ophthalmology/the-orbit-orbital-septum-and-eyelids/) - [Visual fields: confrontation, Amsler grid and perimetry](https://durgical.com/en/ophthalmology/visual-fields-confrontation-amsler-grid-and-perimetry/) ## Related conditions 5 - [Ectropion and entropion](https://durgical.com/en/conditions/ectropion-and-entropion/) - [Dry eye disease](https://durgical.com/en/conditions/dry-eye-disease/) - [Horner syndrome](https://durgical.com/en/conditions/horner-syndrome/) - [Myasthenia gravis](https://durgical.com/en/conditions/myasthenia-gravis/) - [Thyroid eye disease (Graves orbitopathy)](https://durgical.com/en/conditions/thyroid-eye-disease/) ## In Pharmacology 2 - [Warfarin](https://durgical.com/en/pharmacology/warfarin/) - [Clopidogrel](https://durgical.com/en/pharmacology/clopidogrel/) [← All of ophthalmology](https://durgical.com/en/ophthalmology/) Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once. Sources: [Upper Eyelid Blepharoplasty](https://www.ncbi.nlm.nih.gov/books/NBK537078/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Lower Eyelid Blepharoplasty](https://www.ncbi.nlm.nih.gov/books/NBK448181/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Brow Ptosis](https://www.ncbi.nlm.nih.gov/books/NBK560762/) (StatPearls Publishing (NCBI Bookshelf), 2025); [Retrobulbar Hematoma](https://www.ncbi.nlm.nih.gov/books/NBK576417/) (StatPearls Publishing (NCBI Bookshelf), 2022). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/ophthalmology/eyelid-and-brow-surgery-blepharoplasty-and-brow-ptosis/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/ophthalmology/eyelid-and-brow-surgery-blepharoplasty-and-brow-ptosis/