Blepharoplasty Complications Leading to Litigation

Goals/Purpose: Blepharoplasty was among the most frequently performed facial cosmetic procedure in the year 2021. This operation is performed by a variety of surgical specialties including plastic surgery, ophthalmology, and otolaryngology. The complexity and fragility of the eyelid anatomy can lead to a broad spectrum of aesthetic and functional complications, several of which are avoidable through meticulous preoperative planning and surgical technique. The purpose of this study is to evaluate the patient, procedure, and surgeon factors involved in blepharoplasty complications that lead to malpractice litigation.

Methods/Technique: Westlaw database provided a list of malpractice cases filed for blepharoplasty complications. Only cases that concluded in a jury verdict or settlement were included for further analysis. Details regarding plaintiff demographics, primary and secondary injuries, defendant training, and final outcomes were extracted from the applicable case files.

Results/Complications: Fifty-six blepharoplasty malpractice cases were identified by the database. Thirty-four percent of patients (n=19) underwent at least one additional surgical procedure at the time of blepharoplasty. The most common primary complication for litigation was lagophthalmos (n=19; 34%), followed by visual impairment (n=14; 25%) and significant facial scarring (n=14; 25%). Approximately one-half (n=29; 52%) of plaintiffs also filed for a secondary injury. Negligence was the filed cause for injury in 45% (n=25) of cases. Significantly more plastic surgeons were the defendant compared to ophthalmologists (55% vs 24%; p<0.013) and otolaryngologists (55% vs 6%; p<0.001). Accounting for all 56 cases, verdicts ruled in favor of the defendant significantly more often than the plaintiff (63% vs 29%; p<0.001). This remained true when evaluating only those patients that filed for the complication of lagophthalmos (80% vs 20%; p<0.001). Complications with the most rulings in favor of the plaintiff were visual impairment (n=6, 24%) and severe facial scarring (n=6, 24%). Seventeen cases (30%) received monetary awards, with an average award value of $358,235.00 (range $10,000.00 – $2,000,000.00).

Conclusion: There is pronounced variability in complications of blepharoplasty that lead to malpractice litigation. Patients with lagophthalmos had the greatest number of litigation cases, emphasizing the importance of thorough surgical planning to avoid overcorrection. Successful litigation in favor of the plaintiff occurred equally as often for the cosmetic complication of facial scarring as it did for the functional complication of visual impairment. This may suggest that poor aesthetic outcomes are held to a similar standard as functional complications for blepharoplasty procedures.