Sir: 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. DISCLOSURE 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.