Transient Unilateral Blepharoptosis Following Upper Blepharoplasty: A Case Report and Considerations for Local Anesthetic Use

Upper blepharoplasty is a common aesthetic procedure aimed to address dermatochalasis of the eyelid and improve visual acuity. During the postoperative period, patients may experience complications that are usually minor and transient. However, these complications may adversely affect the healing process, delaying the desired result. Accordingly, we present a case of a 57-year-old female with late and transient unilateral blepharoptosis after cosmetic upper blepharoplasty. Preoperative examination revealed the presence of bilateral upper eyelid dermatochalasis and mild prolapse of the nasal fat pad, normal function of the orbicularis oculi, levator palpebrae superioris and frontalis muscles, without evidence of ptosis. Medical history included hyperlipidemia without other significant comorbidities. We hypothesize that the additional local anesthetic injection at the affected eyelid in combination with the persistent edema could have caused the development of ptosis. Therefore, we emphasize the careful use of local anesthetic solution in cases of blepharoplasty and the detailed preoperative examination of the patients to exclude the presence of preexisting blepharoptosis. Moreover, we propose an intraoperative strategy to reduce the possibility of injury of the levator palpebrae superioris muscle and aponeurosis, and therefore to improve postoperative recovery in upper blepharoplasty.