I am 1 year post op from upper bleph surgery. My surgeon used laser with undisolvable sutures. I have devekoped wide white scars within the eyelid crease but they are very visable when I close my eyes or raise my eyebrows. When eyes ar open there is a slight visable scar on the very inner corner of the eyes. Even after a year the scars still seem to be evolving. My PS (a reputable Occular plastic surgeon) suggested the scars could be cut out with a scalpel, (I think he said he would remove the old sutures- not sure) and re-sutured with a different type type of suture (disolvable) . He said there would be more swelling and bruising than the laser surgery but I would be left with thinner scars. Does this sound reasonable or should I get a 2nd opinion? I trust my PS but am a little nervous about having to go through the healing process again. any input would be greatly appreciated.
is a secondary procedure reasonable for upper bleph eyelid surgery scars?
Doctor Answers (9)
Contrary to popular opinion, laser is not an ideal cutting instrument.
Laser creates a lot of thermal damage in its wake that must be healed by the body. There are very few circumstances in my opinion where a laser makes a better instrument for cutting skin than cold steel. Cold steel does not burn the tissues. Sutures can be rapidly removed helping to minimize the appearance of the wound as it heals. In contrast, the laser weakens the skin edges, sutures must be left in much longer. This is less than ideal. Scar revision is the correct answer. This may or may not improve the appearance of the scar in the long run.
Scar revision for unsightly upper blepharoplasty scar
Thank you for your question. It is reasonable to consider scar revision for upper blepharoplasty scars in the case of unsightly scars 1 year after surgery. Sharp excision of your current scar with careful reapproximation may be an option. If you are uncertain, consider seeking a second opinion as you suggest. Good luck.
Eyelid scar revision
Upper eyelid scar revision is possible. The scar is unlikely to improve much more after one year from the surgery. If you feel uncomfortable with your surgeon, get a second opinion from an oculoplastic surgeon.
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You may consider getting a second opinion about your upper blepharoplasty scars.
I read your concern:
Upper blepharoplasty scars heal as a fine white line in nearly everyone. A wide white line could be improved via scar revision, but my concern is that your scar is visible with your eyes open, in the inner corners near your nose. Scarring where the eyelid skin meets the nose may be difficult to correct, as unsightly webbing may occur in this area. In that regard, you should consider getting evaluated by another reputable, experienced blepharoplasty surgeon before proceeding.
I hope this is helpful for you.
Regards from NJ.
I agree with the other experts' opinions. Namely, laser surgery can, in some people, cause more scarring then a blade. Not only does the body have to heal from the mechanical injury of the wound, but also from the thermal injury of the laser. How do you heal generally, do you have scars elsewhere? Those are other things to take into consideration. Scar revision is certainly a reasonable option, and with a blade, assuming you have enough skin to remove without causing further problems (a discussion to have with your surgeon). You'll have to do it to be able to ascertain if it is an improvement. If you are truly unhappy, then it may be worth that risk to you..otherwise it may be something you'll need to cover up.
Jasmine Mohadjer, MD
Tampa Bay, FL
Revision might improve the scar appearance.
As you know, any incision we make, whether with a knife or with a laser will heal with a scar. It appears that your scar formation may have been more noticeable than is acceptable to you. Is it possible that the scarring was "thicker" than most due to the laser. Yes, that is a possibility. But the fact remains that everyone heals differently and its quite possible that the response was your body's unique healing response.
I believe that the recommendation by your surgeon is definitely reasonable, and certainly may improve the scar appearance. Hhowever it is not a guarentee that your future scar will be any less noticeable than the current one, as your body's response may be the same.
If you have enough tissue on your upper lids, a scar revision would be apropriate at this time. I would agree that switching to cold steel is a good idea
It is reasonable to revise prominent or unsightly scars
Generally if a scar is wide or thick, there may have been too much tension across the closure either by removing too much skin or not closing the incision strongly enough to resist the forced acrossed the closure. Given your description of your upper lid scarring, it is reasonable to surgically revise them by excision or cutting out of the scar. The only concern is if you have enough skin for a relaxed closure to be accomplished; otherwise, the problem is likely to recurr. Sometimes, you can improve the post-op skin closure when the skin is tight, by pre-treating the forehead and glabella with Botox or Dysport 7-10 days before the upper eyelid procedure. This way, there is very little tension across the closure and in 3-4 weeks, the incision is completely healed and will not widen when full muscle activity returns. If the excision does not appeal to you and if the scar is thickened, raised or hyperpigmented (dark), you may consider a fractional CO2 resurfacing with corneal shields. Its a conservative treatment which may need to be repeated in 6 months, but the scar may be much less noticible without the risk of further lid shortening as with a scar excision.
Scar Revision After Blepharoplasty
Generally speaking, upper eyelid surgery heals very nicely with thin, hardly perceptible scars. However, the healing process can vary based on the patient and the situation. I think that your Surgeon is offering a reasonable solution assuming enough skin remains on your upper lids for safe removal. The real question is whether or not you are comfortable with your Surgeon and his ability to correct the problem. The fact remains that if you are unhappy with the scars, they will have to be revised surgically. As an aside: there shouldn't be more bruising and swelling with a scalpel compared to a laser.