Should Blepharoplasty Scars Be Less Evident by Now?

I had eyelid surgery 5 weeks ago and my scars are still prominent even with makeup. I have followed recovery instructions and use an oitment my doctor had me start 5 days after surgery to hasten healing.

My scars are not only a very visible and long redline, they also are thick and raised -- very promenent when I close my eyes and touch my scar. The doctor said this is no problem, such evident scaring is normal at 5 weeks. However, I have read in more than a few articles and websites that eyelide scars should be not much noticeable by this time.

Am I impatient? Or, if red, thick texture lines at 5 weeks is not usual, what should I do? This is my second eyelid surgery. Does that make a difference?

Doctor Answers 16

All incision scars go through a maturation phase

This is a good question.

Whenever you have a wound or incision, the healing scar must mature, which involves multiple phases of collagen transformation. At six weeks, the collagen is the thickest and then over several weeks flattens. At the same time, the overlying epidermis of the skin turns red or pink and then over several weeks returns to your normal skin color. However, incisions may still be distinguishable depending on factors which you really can't control - genetics, infection, etc. However, blepharoplasty incisions tend to heal very well. The best way to help your incisions is to leave them alone and allow the healing process to occur. Many ointments and lotions cause irritation, especially with continued use. Another important factor for healing incisions is to protect them from the sun with SPF lotion or, as in the case with blepharoplasty, wearing sunglasses.

I hope this was helpful.

David Shafer, MD
NYC


New York Plastic Surgeon
5.0 out of 5 stars 63 reviews

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Don't panic, but there may be ways to speed blepharoplasty recovery

Don't panic. Upper eyelid incision scars usually heal beautifully with barely perceptible lines. Occasionally, these incisions will take longer to heal, especially if large amounts of skin were removed or the incision was extended farther to the outside to remove more skin.

The skin involved in healing is thicker in these situations and can take longer and remain thicker for a longer period of time. All this being said, what I usually have my patients do is to massage the scars gently 3-4 times per day and try to avoid using makeup or cosmetics that may create further irritation, redness, and swelling.

I also offer my patients pulsed-dye laser treatments combined with some injections to speed the softening, flattening, and redness reduction of their scars. Time alone will help clear the scars, but these treatments can speed things along.

Edgar Franklin Fincher, MD, PhD
Beverly Hills Dermatologic Surgeon
5.0 out of 5 stars 1 review

Patience is a virtue

Unless you have an infection, you should be patient as scars of the uppr lids are usually the most imperceptible. Sometimes, if large amounts of skin is removed, there can be a noticeable transition between thicker skin of the upper part of the lid and the thinner skin of the lower part of the lid.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 8 reviews

Thick, red, raised eyelid scars are not normal after 5 weeks

Of course, you are understandably anxious, and may not be describing things quite accurately, but if your scars are as prominent as they sound, then there is a problem. Hypertrophic scars or keloids are almost unheard of in the eyelids, so I am not sure what to suggest, but definitely talk to your doctor.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Be patient

While all patients scar differently, most upper eyelid scars heal very well. In general scars in most places tend to look fairly red and inflammed at about the 6-8 week mark, and continue to mature for up to a year, somtimes longer. I would tell you to wait several months before considering doing anything else. The thickness of the scars should also improve during this time. It should not make much of a difference that this is your second eyelid surgery.

Vishal Kapoor, MD
Beverly Hills Plastic Surgeon
4.5 out of 5 stars 8 reviews

Blepharoplasty Scars

Blepharoplasty scars should not be noticeable. If you look at my gallery, you can get close uo views of eyes and incision sites (link below) Without photos I can't make exact suggestions, but there are options to improve your situation. 

Cosmetic lower eyelid surgery has undergone a paradigm shift over the twenty years since I began my plasticsurgery training, as has facial rejuvenation surgery as a whole. The trend has been to move away from highly invasive procedures that focus on skin and fat excision and pulling skin structures as tight as possible (which tends to make a patient look less youthful and more like a stereotypical ‘plastic surgery patient’), and towards procedures that accomplish not only soft tissue preservation but also soft tissue enhancement – in the form of structural fat grafting. A typical 1970-1980’s era lower blepharoplasty usually consisted of the surgical removal of large volumes of lower lid fat, pulling the lower lid skin very tight and anchoring the lid laterally in a manner that often distorts the natural anatomy of the lateral canthus (lateral corner of the eye). I suppose you could say that this matches a windswept, pulled tight facelift - but it is not in any way truly rejuvenating.

Current, state-of-the-art lower blepharoplasty focuses on soft tissue preservation, including some or most of what appears to be ‘herniated fat’. A number of techniques have been described that restore ‘herniated lower lid fat’ to a more ideal anatomic position, although ideally such a procedure leaves the orbital septum intact as shortening of the septum by suture tightening or cauterization carries with it some risk of lower lid retraction. 

The trend has been towards limiting fat reduction to primarily older patients with very prominent lower fat pads. In many cases, the appearance of lower lid fat pad fullness can be effectively corrected by a combination of structural fat grafting of adjacent hollow areas like the tear troughs, elevation of the midface and smoothing of the lid – cheek junction by means of a High-SMAS facelift (if indicated), and tightening the orbicularis oculi muscles to the lateral orbital rim – which effectively restrains the fat pads and improves lower lid contour. Lateral orbicularis oculi muscle suspension is a very powerful means for reversing lower lid aging changes, and for doing so in a manner that does not distort natural lower lid external appearance.

Preserving lower lid fat as much as possible, and restoring fullness in adjacent hollow areas by means of fat grafting, is a truly rejuvenating approach to lower lid surgery. Preserving and adding fat serves to enhance the soft tissue support of the lower lid and helps to maintain an ideal and youthful lower lid position over time. The more support you provide for the lower lid, the less you have to rely on internal support measures such as canthopexy and canthoplasty, which are useful for very lax and for overly long lower lids, but which also may distort the natural anatomy of the lower lid and upper lid.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 49 reviews

At six weeks, scars are at their worst

Eyelid and skin incision scars go through a healing process. At six weeks, incision are at their worst in appearance so I wouldnt worry. I would avoid the sun because that tends to prolong the healing. If you have had a cut before you would know that the instant you had a cut, it didn't look that bad. However over a couple days it got red, left a scab and then started healing. These incisions should resolve without a problem within the next several months. This is still in the early stage of the game.

Chris Thiagarajah, MD
Washington DC Oculoplastic Surgeon
5.0 out of 5 stars 6 reviews

Eyelid incisions

At this point in time the incisions should still be visisble...however the desciption of thickened may be more than expected. You should go beck to see your physician regarding this matter

5 Weeks Is Early to Worry But You Can Start Treating Eyelid Crease Scarring

I am sorry to learn about your concerns. After 5 weeks I would still expect your being able notice the eyelid crease incision ( I assume your are speaking about an upper eyelid surgery.) Everyone is different in the amount of time that this takes to heal. If the area is raised you can very gently massage the area 2-3 x/ day for 5 minutes. Please also speak to your cosmetic surgeon about creams that can be massaged into the area to improve the line faster.

As an Ocular Plastic Surgeon I am routinely asked to improve incision lines and contours of the eyelid after blepharoplasty. Some patients need to have the scar line removed and resutured; others can benefit from laser skin resurfacing; but more often than not watchful waiting is all that is necessary.

Lower eyelid surgery is accomplished at my office without any skin incision at all. I gently remove the fullness (fatty tissue ) from the inside of the eyelid. I then tighten the skin with CO2 (carbon dioxide) laser resurfacing. NO stitches, NO skin Incision and NO scalpel.

Being your second eyelid surgery should not make a difference in the healing of the skin unless you had a lot of scar tissue from the prior procedure.

Mark Berkowitz, MD
Sterling Heights Oculoplastic Surgeon
5.0 out of 5 stars 21 reviews

Should Blepharoplasty Scars Be Less Evident by Now

Blepharoplasty scars can be prominent at five weeks. This can be very individual and your genetics play a role but it is not that unusual. I find that it takes about 3 1/2 months for scars to fully settle down for most. Do remember, although they may appear very prominent to you, others may not be able to notice your scars unless you point them out. If it is your second surgery as you indicated, pre-existing scar tissue may trap a bit of swelling longer than someone undergoing a primary blepharoplasty and it may take longer for your scars to settle.

George Volpe, MD
Boston Plastic Surgeon
5.0 out of 5 stars 6 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.