I had upper and lower eye lid surgery 9 weeks ago and I can see a scar forming in both upper eye lid area close to the tear duct going towards lower eye lids. My surgeon told me this does not happen usually. He injected me with diluted cortisone three times already but I see no difference. Please help me I am very scared. I am not happy with the results. Is this normal. Thank you
Scarring After my Eye Lid Surgery? (photo)
Doctor Answers (10)
Why eyelid scarring can occur during the healing process, and how it can be avoided using precise incisions
This type of fold or web can happen in different case scenarios. The most common scenario is when the skin in the inner aspect below the medial part of the incision is relatively loose. This means that a certain amount of skin was removed and because of the dynamics of tension, a fold can occur. This type of folding is most common in the skin between the eyelid and the nasal area. Another scenario is when the incision line plays a role in the way the skin heals - it can heal a little or aggressively until it thickens.
Web development is generally managed conservatively through massage or the use of steroid and anti-scarring injections. This requires some time to work and great observation of the scar is done. When I see patients who have this, I would wait until the active healing has already occurred. Active wound healing occurs when the initial healing process or collagen remodeling begins to tighten the area until the collagen softens after several months after the surgery. I would also wait around 6 months before pursuing a different procedure to flatten the web or scar.
Another procedure that can help with the webbing and scarring is called a z-plasty. This procedure takes advantage of certain geometric rules. If the skin has relative shortage, then the skin can be moved in such a way to give an absolute amount of skin to compensate for the tension and shortage. At this point, I think the use of steroids is adequate for your case. I would also would suggest doing massage of the area, but first communicate with your doctor if this will be beneficial to your case. I hope that was helpful, I wish you the best of luck, and thank you for your question.
While I understand it is easy to get concerned, your situation may very well improve on its own as 9 weeks is still early in the healing process and the acute inflammation that occurs will very likely improve. If your lids are unsatisfactory at 6 months, that would be the time to seek a second opinion.
It takes longer than nine weeks for scar to remodel after blepharoplasty.
I think your scar will improve without steroids and without massage. I would be more concerned about the lower lid position.
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Steroids and other injections as well as time and massage may ease the appearance. A revision of the canthal web with Z-plasty is reasonable after a few more months. Kenneth Hughes, MD Los Angeles, CA
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Thank you for the picture and the question. While it is still early, I agree with the others that you appear to have a fold of skin or a web of scar at the medial aspect of the incision. This can result from making the incision too close to the nose. After all of the swelling has resolved and the tissues have settled, this can be corrected with a Z-plasty (a scar revision technique).
Upper lid scarring resulting in epicanthal folds
Discuss options beyond steroid injections with your surgeon and see what his revision policy is. Your folds/contracted scars can be managed with z-plasties so realize can achieve a better result.
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Pre op photos and a clinical exam are imperative to give specific advise. When your tissues soften u could consider a z-plasty in order to correct the deformity depicted in your photo. Ask your surgeon for a referral for a second opinion
Webbing of upper lid
Thank you for your photograph. You have cicatricial scarring of the upper lid. Typically the incision does not come that close to the nose. Steroids have been unsuccessful therefore surgery is your next step. Best way to resolve this is the use of tissue rearrangement. This can be done by a W plasty or a Z-plasty. This is a small outpatient procedure. Seek an experienced BC PS to help you resolve this.
Epcanthal fold after an upper eyelid blepharoplasty
It appears that you have a fold of skin possibly due to the incison being carried too close to the nasal skin. It is impossible to say without a pre-operative photograph. This can be corrected surgically with a Z plasty if the steroids do not work. I would definetely give it more time to resolve.