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Lelli, Gary J. Jr. M.D.; Zoumalan, Christopher I. M.D.; Lisman, Richard D. M.D.

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Plastic and Reconstructive Surgery: September 2010 - Volume 126 - Issue 3 - p 1113
doi: 10.1097/PRS.0b013e3181e6cf92
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We thank Drs. Lazzeri and Agostini for their letter1 and have read with great interest their comments on our recently published article “Blepharoplasty Complications.”2 Although it is exceedingly rare, necrotizing fasciitis of the eyelids can occur following blepharoplasty and imparts significant risk to the patient—namely, cosmetic deformity and the potential for permanent vision loss and death. For that reason, the ability to suspect this diagnosis, recognize it, and initiate treatment is imperative for the surgeon who performs blepharoplasty. The review by Drs. Lazzeri and Agostini of the signs and symptoms of this process is appreciated.

As mentioned, four cases of eyelid and periorbital necrotizing fasciitis have been reported following aesthetic surgery of the eyelids.3–6 Based on the upcoming review of necrotizing fasciitis of the periorbital region by Lazzeri et al., it is helpful to note that this process is more common in patients older than 50 years and in those with associated chronic comorbidities,7 although one of the four cases reported after blepharoplasty was in a 36-year-old patient.4

In sum, we agree that necrotizing fasciitis should be considered an extremely rare and serious complication that can occur after blepharoplasty surgery. The diagnosis should be suspected when warranted, and appropriately rapid and aggressive multidisciplinary treatment should be undertaken to lessen the chance of serious sequelae for the patient.


The authors have no financial conflicts or interests to report in association with the contents of this communication.

Gary J. Lelli, Jr., M.D.

New York Presbyterian Hospital

Weill Cornell Medical Center

Department of Ophthalmology

Division of Ophthalmic Plastic, Reconstructive, and Orbital Surgery

New York, N.Y.

Christopher I. Zoumalan, M.D.

Richard D. Lisman, M.D.

New York University

Langone Medical Center

Department of Ophthalmology

Division of Ophthalmic Plastic, Reconstructive, and Orbital Surgery

New York, N.Y.


1.Lazzeri D, Agostini T. Eyelid and periorbital necrotizing fasciitis as an early devastating complication of blepharoplasty. Plast Reconstr Surg. 2010;126:1112–1113.
2.Lelli GJ Jr, Lisman RD. Blepharoplasty complications. Plast Reconstr Surg. 2010;125:1007–1017.
3.Ray AM, Bressler K, Davis RE, Gallo JF, Patete ML. Cervicofacial necrotizing fasciitis: A devastating complication of blepharoplasty. Arch Otolaryngol Head Neck Surg. 1997;123:633–636.
4.Jordan DR, Mawn L, Marshall DH. Necrotizing fasciitis caused by group A streptococcus infection after laser blepharoplasty. Am J Ophthalmol. 1998;125:265–266.
5.Suñer IJ, Meldrum ML, Johnson TE, Tse DT. Necrotizing fasciitis after cosmetic blepharoplasty. Am J Ophthalmol. 1999;128:367–368.
6.Goldberg RA, Li TG. Postoperative infection with group A beta-hemolytic streptococcus after blepharoplasty. Am J Ophthalmol. 2002;134:908–910.
7.Lazzeri D, Lazzeri S, Figus M, et al. Periorbital necrotizing fasciitis. Br J Ophthalmol. (in press).

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