I had an upper blepharoplasty done 15 weeks ago. The scars are still bumpy, and on one lid, there's a prominent red bulge. I've been massaging and using Dermatix (30 days so far), as directed by my doctor, but it doesn't seem to be getting any better. Should I be concerned at this point? I did not have dissolvable sutures.
Upper Blepharoplasty Scar Healing Problem?
Doctor Answers (17)
Firm nodule in blepharoplasty scar
I would agree with the comments of others made here. It is not uncommon to have an inclusion cyst along the suture line. Occasionally, these get inflammed and other times they get infected. Treatment typically consists of evacuating the cyst.
Alternatively, it could be an inflammed nodule that would benefit from steroid injection.
Seek the advice of your surgeon and proceed with his/her recommendations.
You have suture cyst
Please ask your doctor to revise the scar and to remove the cyst. This not rare but will not go away by itself. If your doctor does not want to treat this ,find another surgeon.
Your surgeon needs to be more aggressive
The upper lid is the best scarring area of the body. Most patients look great even after a week. Although all scars can become reddened this usually occurs around the 4 week mark. I agree with the other surgeons that this red area is an inclusion cyst, small stitch reaction from a deeper stitch or if this has been enlarging rapidly could be a pyogenic granuloma (unlikely).
Some lesions will do well with a tiny amount of steroid. Or this scar may just need a minor revision to improve it. Either way have your surgeon address this more aggressively
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Upper Bleph Scar, Consider Kenalog
The only thing that I would add to the excellent comments of the other physicians is speaking to your surgeon about the possibility of a very dilute and very small quantity of a steroid injection (0.02-0.05 cc of Kenalog-10) directly into the scar tissue.
I hope that your scar resolves quickly.
By 15 weeks, blepharoplasty scar should be quiet
We don't have pictures but by this time frame, the bleph scar should be quiet even if the doctor had used absorbable stitches. Still, it is quite common to develop a small incision cyst along the bleph incision. This represents a small bit of surface skin that gets trapped below the skin surface. The skin element grows and gets walled off to form a small cyst. If you do have these, they typically do not go away on their own but require a small office procedure to remove.
This type of procedure is generally so minor that it does not qualify as a revisional procedure. There is typically very little down time. The red bulge is numbed and excised. When these cysts are quiet, the skin can be just cut open with a small needle and the cyst expressed. Contact you surgeon and ask for the nodule to be removed. Alternatively, an oculoplastic surgeon in your area can address this issue. Find such a specialist in you area by looking on the ASOPRS.org web site.
Bleph Scar Bulge
Thanks for your question Nancy -
That bulge may be an absorbable suture that is disolving. You should ask your surgeon if they used any dissolving suture (in addition to discussing your concerns about the healing).
At 15 weeks your incision should be faint, thin and not red.
I hope this helps.
Red bump 16 weeks after blepharoplasty is unusual
The most common cause of a red bump 16 weeks after upper blepharoplasty is a retained suture or suture abscess.
Sometimes, a small piece of suture is left behind in the skin after suture removal, and this can inflame the skin and leave a red bump. Probing and removing the suture will resolve this.
If the doctor used resorbable sutures under the skin, a small abscess can form around the suture and create a red bump.
Your doctor can sort this out.
Consult with Your Surgeon as it Looks Like You May Have an Inclusion Cyst that May Require Surgical Excision
After three months, most upper eyelid incisions have minimal redness. The bump on your upper eyelid suggests the possibility of hypertrophic scarring or an inclusion cyst. An inclusion cyst can occur when the outer layer of skin is turned inside out and as a result, grows inward forming a cyst. It can also occur when retained suture remnants are left in place. Infection and resultant inflammation can create the redness and tenderness that you describe. Bumps like this can also be seen with hypertrophic scarring. Sometimes, chronic inflammation can create a raised tender scar,
Early in the post-operative period we generally recommend massage. However, at this point surgical excision might be considered. You should consult your plastic surgeon for his opinion regarding this eyelid lesion.
Incisions on upper lids undergo lumpy-bumpy phase
The incisions on the upper lids tend to undergo a lumpy-bumpy phase one to three months after the surgery. All of this phase tends to settle down where the lumpy-bumpy pink incision will turn to a fine little white line hidden in the natural crease. On rare occasions, a small milia may turn into a pimple right at the incision line, and this needs to be expressed with a small needle and Q-tips.
Postoperative Blepharoplasty Cyst
Swelling of the upper eyelid incision may likely represent a cyst, either from a trapped suture deep in the skin or trapped epithelium under the skin. More concerning causes for this swelling may be infection / abscess or early scarring. Most expected swelling and redness after blepharoplasty usually only lasts a short period time, and 15 weeks is unusually long.
Treatment is relatively minor which may include a minor revision procedure, stab incision and drainage of fluid, antibiotics, steroid injection, warm compress, and massage. Watchful waiting is another option, depending on complete evaluation.
Speak to your plastic surgeon again, and discuss these various options.