7 Side Effects and Contraindications You Must Know Before Choosing Eye Surgery

Eye surgery is performed on a sensitive area that occupies the center of the face. If you only consider cosmetic changes, it can lead to serious complications. This article is based on thousands of cases experienced by Dr. Kim Jae-ryong of Kim Jae-ryong Plastic Surgery over a 25-year career, and organizes absolute contraindications and dangerous situations to avoid in eye surgery focusing on specific cases. General surgical principles and types are covered in our comprehensive guide; this article focuses on the risk factors you must know before deciding on surgery.

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One of the most common side effects after double eyelid surgery is reduced ability to open eyes. In particular, if someone whose eye-opening muscle (levator palpebrae superioris) is already weak gets an excessively high double eyelid line, they must use more forehead muscle strength to fully open their eyes. Over time, forehead wrinkles deepen, and paradoxically, the eyes appear smaller.

Specific case: A woman in her 40s returned 6 months after surgery wanting high double eyelids, complaining of difficulty opening her eyes and severe forehead wrinkles. Examination revealed that the excessively high line had worsened her pre-existing weak eye-opening ability. In this case, revision surgery to lower the line or eye-opening muscle reinforcement (Müller muscle enhancement) was necessary.

Contraindication criteria: If pre-operative examination shows signs of ptosis, avoid high line adjustments.

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Some people with puffy under-eyes remove fat excessively. Initially, swelling decreases and the eyes appear bright and shiny, but 3-6 months later, a hollowed eye phenomenon appears where the under-eye area sinks inward. This occurs when the fat that supported the under-eye structure disappears, and once severe, it is nearly impossible to fully recover.

Specific case: A man in his 30s working in an office wanted to eliminate dark circles and underwent under-eye fat removal surgery. He was very satisfied for the first month, but 6 months later, his eyes appeared overly sunken, and others noted he looked tired and aged. Revision surgery requiring autologous fat or filler grafting was necessary, but restoration to the original state was impossible.

Contraindication criteria: If under-eye fat is only slightly puffy, choose repositioning rather than complete removal. People with very low under-eye subcutaneous fat should also avoid large-scale removal.

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Inner canthoplasty (medial canthus incision) expands the inner corner of the eye, but if the incision is imprecise or mistakes occur during suturing, scars remain prominently. The risk is particularly high for people with thin skin, poor wound healing ability, or keloid-prone skin.

Specific case: A woman in her 20s wanted her eyes to look sharper with inner canthoplasty, but at the 3-month mark post-surgery, red scarring remained on the medial aspect of the inner eye. The cosmetic mark became more pronounced, and ultimately she required over 6 laser treatments with complete removal remaining difficult.

Contraindication criteria: People with a history of keloid or hypertrophic scarring, or thin-skinned East Asians (especially those with sensitive skin types) should carefully review inner canthoplasty. If you cannot accept the scar risk, non-incisional procedures may be a better alternative.

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The eyes are naturally not perfectly symmetrical left to right. However, if surgery makes changes to only one side, or if you assume symmetry and operate equally on both sides, asymmetry can become more pronounced. This problem particularly occurs when double eyelid line height, eye angle, and under-eye fat distribution are subtly different.

Specific case: A 35-year-old woman underwent double eyelid surgery on both sides, but post-operatively one eye had a higher, sharper line while the other appeared slightly blurred. Originally her eye-opening strength differed by about 5%, but the surgery amplified that difference more than 10-fold. In this case, revision required lowering one line or matching eye-opening muscle strength levels.

Contraindication criteria: During surgical planning, photographic analysis, actual measurements, and eye-opening strength testing must accurately identify left-right differences. Targeting "perfect symmetry" pre-operatively is actually risky.

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Swelling immediately after eye surgery is normal, but some patients who aggressively resume daily activities during the first 2 weeks experience persistent or worsening swelling. In particular, activities like computer work, driving, intense exercise, prolonged walking, and lifting heavy objects must be avoided.

Specific case: A man in his 50s returned to work just one week after double eyelid surgery. His job involved frequent head-down positioning, which increased blood flow around the eyes, and swelling had not subsided even after one month. More problematic was that the swelling caused the double eyelid line to settle lower than originally planned, resulting in unsatisfactory final results.

Contraindication criteria: The first 2 weeks post-surgery require complete rest. Do not rub your eyes, avoid prolonged phone viewing, contact lens wear, and eye makeup. Do not resume exercise without medical staff approval—delay for at least 4 weeks post-surgery.

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Eye surgery, particularly procedures involving the eyelids and under-eye area, can damage corneal surface nerves and lacrimal glands. People with pre-existing dry eye may experience worsening symptoms post-surgery, and in severe cases it can progress to keratitis or corneal ulceration.

Specific case: A 55-year-old woman underwent under-eye fat removal and ptosis correction surgery. Post-operatively, dry eye sensation became severe, requiring artificial tears over 10 times daily. Ophthalmology examination revealed tear secretion decreased 30% compared to pre-surgery, ultimately requiring over 6 months of specialized dry eye medication treatment.

Contraindication criteria: People already diagnosed with dry eye or those with prior vision correction procedures (LASIK/LASEK) must have mandatory consultation with an ophthalmologist before eye surgery. If necessary, dry eye treatment should be stabilized before scheduling surgery.

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Eye surgery changes appearance but does not resolve fundamental self-esteem or life problems. Some patients become dissatisfied post-surgery and fall into a surgery addiction state, repeatedly requesting revision procedures. This may relate to Body Dysmorphic Disorder (BDD).

Specific case: A woman in her 30s was satisfied after double eyelid surgery but 3 months later underwent under-eye fat removal, 1 year later inner canthoplasty, and 2 years later outer canthoplasty—progressively all eye surgeries. With each procedure she expected "the next surgery will be perfect," but remained dissatisfied throughout. Eventually mental health professional consultation became necessary, and additional surgery was no longer recommended.

Contraindication criteria: If your reason for surgery is "doing what others do," "compulsion toward perfection," or "expectation that all problems will resolve after surgery," first seek psychological counseling. If medical staff judge your expectations unrealistic, surgery should be deferred initially and counseling therapy pursued first.

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| Risk Situation | Symptoms/Signals | Response Method | Absolute Contraindication |
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| Weakened eye-opening | Already diagnosed ptosis, many forehead wrinkles, difficulty opening eyes | Abandon high lines, eye-opening muscle testing essential | Absolutely |
| Under-eye hollowing | Low under-eye fat, very lean build, severe dark circles | Prohibit excessive fat removal, choose repositioning only | Not recommended |
| Scar risk | Keloid/hypertrophic scar history, very thin skin, sensitive skin | Avoid incisional inner canthoplasty, use non-incisional alternative | Absolutely |
| Left-right asymmetry worsening | Already have size/line differences between eyes | Don't force symmetry, focus on harmonious surgery | Caution |
| Swelling worsening | Plans for strenuous activity in early recovery (2 weeks) | Adequate recovery period (4 weeks) essential | Not recommended |
| Dry eye | Already diagnosed with dry eye, prior LASIK/LASEK experience | Ophthalmology consultation essential, dry eye treatment first | Caution |
| Psychological dissatisfaction | Obsessive perfectionism, continued dissatisfaction after prior surgery | Psychological counseling first, consider surgery deferral | Absolutely |

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Answer the following questions honestly:

"Is surgery motivation my own strong desire, or due to others' views?" → If the latter, deferral recommended

"Do I already have eye-related conditions or weaknesses?" (ptosis, dry eye, scar-prone skin) → If yes, consult extensively with medical staff

"Can I allow sufficient recovery time?" → 2-4 weeks of stress-free rest essential

"Am I prepared to be satisfied with one surgery?" → If revision desire is high, pursue psychological counseling first

"Can I follow medical staff advice and restrictions?" → Self-directed action worsens results

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Q1: I've been diagnosed with ptosis. Do I absolutely cannot have double eyelid surgery?

A: Not necessarily prohibited, but high lines are risky. Medical staff must accurately assess your eye-opening muscle status, then plan low to moderate height natural lines. If necessary, consider Müller muscle enhancement concurrently.

Q2: I developed hollowed eyes after under-eye fat removal. Can it be filled again?

A: Autologous fat grafting or filler can provide some improvement, but perfect restoration to original state is difficult. This is why avoiding excessive removal in the first surgery is critical. Prevention beforehand is most important.

Q3: I have scarring after inner canthoplasty. Can it be removed?

A: Within 3 months post-surgery, consulting with medical staff allows suture adjustment or scar treatment (laser, steroid injection, etc.). However, if much time has passed, scarring becomes established and complete removal becomes difficult. Careful post-operative management is key.

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Eye surgery is not simply a possible procedure, but a medical intervention that must be carefully decided after comprehensive evaluation of your eye condition, health, and psychological state. If any of the 7 side effects and contraindications mentioned above apply to you, reconsider surgery or first review safer alternative methods.

Especially if you already have eye-related conditions, consultation at a medical institution providing co-treatment with ophthalmology is safer than a general plastic surgery clinic. Dr. Kim Jae-ryong of Kim Jae-ryong Plastic Surgery, who accumulated 25 years of eye surgery experience in Seo-gu, Daejeon, follows the principle of "first diagnosing when surgery should be avoided, then performing only within safe ranges" rather than simply "performing surgery." Remember that "not having surgery" can sometimes be the right answer compared to complications from unnecessary procedures.

If you're considering eye surgery, inquire about consultation at 042-477-0011. We can jointly review realistic and safe options suited to your eye condition.