scarring from blepharoplasty information is appreciated
Will I Have Visible Scars from Eyelid Surgery?
Doctor Answers (85)
Techniques and tips for reducing eyelid surgery scars:
Upper and lower eyelid surgery scars are among the best scars a patient can receive, IF the surgeon uses precise technique, fine sutures, proper incision location, and the patient follows post-op directions well.
Upper eyelid incision are hidden by the lid fold (except in Asian patients, who may not have this fold). Care must be taken by the surgeon to not go too high, too low, or too far laterally near the crows-foot area, or the scar may be more visible. Likewise, too much skin removal can cause excessive tension on the closure and affect healing adversely. I mark and measure my patients pre-operatively while upright and alert (no medication or sedation on-board) to determine the accurate true amount of skin excess to remove. Finally, the choice of suture material and closure technique can influence the scar's quality. I use a very fine (6-0) monofilament nonabsorbable suture woven from inside the skin incision edge to the other side of the skin incision edge (subcuticular closure) and left in one piece for both lids. When it is ready to be removed in a week or so, I simply slide the suture from the skin by pulling from the center where the stitch is exposed. Minimal discomfort, no cross-hatch marks, great scar (but somewhat more difficult to do). Many surgeons simply use an easy over-and-over baseball stitch and remove it before it leaves (bad) marks, but it can leave tiny suture hole scars or cross-hatch marks if it is too tight, left in too long, or if the patient has more swelling than "average." Sleeping with your head elevated above heart level for at least two weeks helps keep swelling to a minimum. The same goes for avoidance of lifting, straining, or vomiting after surgery!
Lower eyelids are even more tricky to do well, and even skilled, experienced surgeons can have difficulties with proper tension, lid position, and scarring (not just the visible skin scar, but the ones beneath the surface that can pull or distort the lid during healing). At least the skin scar can be virtually invisible, if the scar is placed just below the eyelashes--not several millimeters below, which I commonly see (to avoid cutting the eyelashes, or just out of habit), but adjacent to the eyelashes. This is hard to do properly and involves utilizing a pointy scalpel blade directed from below the skin upwards, which allows the surgeon to place the incision much closer to the eyelashes, giving a scar which heals better than virtually all others. When I use this special technique for external lower eyelid incisions, I use very tiny absorbable sutures for closure. These dissolve within a week, do not leave a mark, and do not require trying to decide what is an eyelash and what is a suture (for removal). Of course, if you only have a tiny amount of fat to be removed, the incision can be hidden inside the eyelid, and this is completely invisible. But this incision does not allow any lid tightening or skin/muscle smoothing.
Even with "standard" methods, eyelid scars heal beautifully for the vast majority of patients and surgeons, usually even if you form bad scars elsewhere. But with these tips and techniques, I believe scars can be even better.
Scars From Blepharoplasty Are Usually Very Hard to See
The good news is that the scars from Blepharoplasty are very hard to see.
The upper eyelid incision is placed in the natural crease.
The lower eyelid incision is placed in a wrinkle just below the lash line, or inside the lower eyelid where it cannot be seen.
Eyelid scars are minimal and fade well with time
Because eyelid skin is very thin and delicate, usually eyelid scars fade well. besides there are usually positioned in the eyelid crease and extend into the crows feet, therefore, they don't show much.
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Bleph scars are favorable
The thin skin of the upper and lower lids is very favorable when it comes to scars. Every incision has to leave a scar, but these areas heal better than most if not all other body sites. The upper lid incision sits in the natural crease where the eyelid folds as you open and close. That means it often tricks the viewers mind to think it is just the crease. The lower lid incision is so close to the lower lashes that it too is virtually hidden. The only thing to keep in mind is that the upper lid skin in particular, especially laterally, will take a long time for allthe irregularities to settle. So I counsel my patients to remain patient, since small lumps and bumps that are a normal part of healing will all resolve over 6-12 months.
Hidden scars in blepharoplasty
All surgery produces scars but the scars from blepharoplasty should be nearly invisible due to their location directly in the crease of the upper eyelid and just barely beneath the lashes of the lower eyelid. The skin/dermis of the lids is also very thin and typically heaals with very minimal scars. Rarely will a patient, who is genetically predisposed to abnormal scarring, have a firm or red/raised scar develop. There are a variety of treatments available to correct this, should it occur
Scars from Blepharoplasty
You will always have scars from any procedure that you have. What makes plastic surgery an art is how to do them so that they are not so noticeable. That is were you need to find an experience Facial Plastic Surgeon for your procedure.
You will always know were your incisions are, specially if they are done trans-cutaneously, but this should not be the concern. Eyelids is one of the areas of the body that heals the best and usually does not bring a lot of scaring.
Scars are typically minimal
The eyelid skin is the thinnest in the body, typically correlating with fairly imperceptible scars.
With upper eyelid surgery, the only exception to this rule is if the incision is carried too far toward the nose (where the skin is thicker), a webbing effect can occur. This is an easy complication to prevent. Small whitehead or milia can occur after eyelid surgery, but are easy to treat without major adverse sequellae.
Lower eyelid surgery is vastly more complicated than upper eyelid surgery since the lower lid has less support (accounting for only 5% of eyelid closure). If skin is to be removed, it must be done in a tension free environment to prevent a rounding effect, or pull-down of the lower eyelid (known as ectropion). Some patients are really not good candidates for lower lid procedures due to a lack of support in the cheek area (termed a negative vector). To determine this, a thorough consultation with a surgeon experienced in eyelid surgery is necessary.
Scarring Following Blepharoplasty
Anytime an incision is made, scarring will occur to some degree. The eyelid is an area where scarring is usually minimal and the scars are well hidden in this location. It usually takes about twelve months for scars to reach maximum recovery.
Local wound care can minimize the potential for adverse scarring following surgery. In the immediate post-operative period, removing sutures in a timely manner can minimize adverse scarring. Avoiding crusting and scabbing of the eyelids by keeping them lubricated with ointment can minimize indentations in the scar. Avoidance of infections can minimize hypertrophic scarring and spread of the scars.
When these steps are followed, most patients have excellent healing with almost inperceptable scarring. Occasionally, wound healing complications can occur and secondary surgery is required, but these situations are fortunately rare.
Incisions After Eyelid Surgery
Will I Have Visible Scars from Eyelid Surgery?
With Upper Blepharoplasty the incision can be hidden in the natural skin crease, which means although there is a scar after surgery. The scar is virtually invisible as it is hidden in this natural skin crease. Care is required with the surgical technique in position the skin crease as a person’s eyes and facial appearance can be changed if attention is taken to the detail of the upper eyelid. We have corrected the position of this scar when the scar has been placed by other surgeons without due care or attention, too high the scar becomes visible and unnatural. Closure of the skin with stitches also can effect the healing of the scar. Non-absorbable stitches that require removal are generally preferred as these cause minimal irritation of the skin surfaces and minimise scarring. After the surgery, like all scars anywhere in the body, the scar can initially be thicker in texture and occasionally have small bumps. With time the fibers remodel and the scar thins over a period of months, massage of the scar may aid this process. In most people after 12-months the scar in the upper eyelid is barely visible.
Some individuals may have a medical condition that causes increased scarring, termed Keloid scarring. If you have a keloid scarring you should inform you surgeon. The skin around the eyes is relatively unique as the thinnest skin in the entire body, this appears to offer protection against keloid scarring in the eyelid area.
In lower eyelid surgery, the Lower Blepharoplasty can be completed through the skin (trans-cutaneous) or the inside lining of the eyelid (trans-conjunctival). My preference is the trans-conjunctival blepharoplasty which avoids any scars in the lower eyelid.
Some surgeons’ prefer the older skin incision technique (trans-cutaneous blepharoplasty), although technically more straightforward, it always leaves a scar in the skin. The scar can be seen immediately below the eyelashes in the lower eyelid. After months the scar does fade, particularly in Caucasians, however can not be made invisible unlike with the trans-conjunctival approach.
Overall, modern surgical techniques can make scarring after blepharoplasty very difficult to be seen.