Blepharoplasty, or eyelid surgery, is a common procedure intended to rejuvenate the eye area by removing excess skin, fat, or muscle from the upper or lower eyelids. While it can significantly improve the appearance of tired or hooded eyes, it is not a suitable option for everyone. A variety of underlying health issues and specific anatomical factors can make a person a poor candidate, leading to worsened conditions or unsatisfactory aesthetic results.
Systemic Health Conditions and Medications
Uncontrolled systemic diseases represent a clear contraindication for elective surgery. Poorly managed diabetes, for instance, severely compromises the body’s ability to heal wounds and raises the risk of post-operative infection. High blood sugar levels can delay recovery and increase the chance of complications.
Uncontrolled high blood pressure (hypertension) also poses a serious risk during and immediately after surgery. Elevated blood pressure can lead to excessive bleeding during the procedure and increase the risk of a hematoma. Surgeons require patients to have their blood pressure effectively managed before undergoing blepharoplasty to mitigate these vascular complications.
Certain lifestyle factors and medications also influence candidacy by impairing circulation and clotting. Heavy smoking is discouraged because it constricts blood vessels, restricting the necessary blood flow and oxygen required for optimal wound healing. Patients taking blood-thinning medications, such as anticoagulants or antiplatelet drugs, face a much higher risk of excessive bruising and bleeding. These medications must often be paused safely before surgery, which requires clearance from the prescribing physician.
Pre-existing Ocular Issues
Conditions affecting the eyes themselves can be exacerbated by blepharoplasty, making patients with these issues poor candidates. Severe dry eye syndrome is a major concern, as the surgery can temporarily worsen tear film instability and lead to discomfort, irritation, or potential damage to the corneal surface. The procedure alters the mechanics of the eyelid and can increase the exposure of the eye, which is particularly risky for those already suffering from chronic dryness.
Patients with glaucoma must be thoroughly evaluated by an ophthalmologist before surgery. The swelling and manipulation involved could potentially affect the pressure dynamics within the eye, requiring careful monitoring. A history of retinal detachment requires extensive consultation with an eye specialist to assess if the stress of the procedure could introduce an elevated risk of further ocular complications.
Prior eye surgeries, such as LASIK or cataract removal, can also complicate the planning and execution of blepharoplasty. These interventions may have altered the local anatomy or healing response, necessitating specialized surgical techniques or deferral of the procedure. Active eye infections or inflammation are absolute contraindications, requiring surgery to be delayed until the condition has fully resolved.
Anatomical Features Requiring Alternative Procedures
Some individuals are not candidates for standard blepharoplasty because the perceived issue is rooted in structural problems that the surgery cannot correct. A common example is eyebrow ptosis, or drooping of the eyebrows, which causes skin to bunch on the upper eyelids. If a surgeon only removes the excess eyelid skin in this scenario, the heavy appearance will persist, and the brow line may be pulled down further, leading to an unnatural look.
In cases of eyebrow ptosis, a brow lift is the appropriate procedure to reposition the brows and address the issue. For the lower eyelids, significant laxity or a history of ectropion (an outward-rolling eyelid) means a simple lower blepharoplasty carries an unacceptable risk of causing eyelid retraction. These patients often require supporting procedures like a canthopexy or canthoplasty to tighten the lower lid margin.
Furthermore, lower eyelid concerns stemming from mid-face descent or malar (cheek) bags may not be solved by blepharoplasty alone. The solution may involve a mid-face lift or volume restoration with fillers or fat grafting to address the skeletal and soft tissue changes contributing to the tired appearance. Individuals with Body Dysmorphic Disorder (BDD) or unrealistic expectations are considered poor candidates, as no technical surgical success will satisfy their psychological needs.