Thick scar eyelid post op 1 year upper bleph - what kind of treatment could you recommend? (Photo)

Question

Hi. I am wondering if you can help me regarding a thick scar on the eyelid 1 year after an upper bleph surgery. What kind of treatment could you recommend? I can’t do a revision on the scar because I don’t have more skin to take off. (2 mm to short even now, having a dry eye symptom) I’m already massaging it every night. I don’t think I can do any lasers either because they will shrink the skin. I am devastated.. what treatment can I do to make it more nicer and more flat? Regards Emmy

Anna Chacon, MD, FAAD · Answer

Hi Emmy, thank you for your detailed message and for sharing your concern. A thick or raised scar one year post-upper blepharoplasty, especially in such a delicate area like the eyelid, can be distressing — but there are still several non-surgical options that may help improve its appearance without compromising skin integrity or exacerbating dryness.

Here are a few considerations:

1. Topical Silicone Therapy
Silicone gel or silicone sheets can help flatten and soften hypertrophic scars over time.

Apply daily for several months — this is safe for the eyelid area and non-invasive.

2. Low-Dose Steroid Injections
Intralesional Kenalog (triamcinolone) can be carefully injected in very small amounts to reduce thickness and inflammation in raised scars.

This should be performed only by an experienced practitioner familiar with eyelid anatomy due to the thin skin and proximity to the eye.

3. Microneedling
Very superficial microneedling, done with precision, may help break down scar tissue and stimulate remodeling without significant skin shrinkage.

Typically done under the supervision of a dermatologist or plastic surgeon.

4. Gentle Topical Retinoids
A low-strength retinoid cream (like tretinoin 0.025%), if tolerated, may improve texture over time by encouraging cellular turnover.

Use with caution around the eyes and avoid if dry eye symptoms worsen.

5. Non-Ablative Laser or RF Microneedling (Cautiously)
While you mentioned avoiding lasers due to risk of shrinkage, non-ablative fractional lasers (like Fraxel Restore) or radiofrequency microneedling may help remodel collagen without significant tightening or thinning.

These should be done with extreme caution and only after evaluating skin laxity and tear film function.

6. Scar-Specific Creams
Consider onion extract-based creams (like Mederma), vitamin E, or Centella asiatica (e.g., Madecassol), though results may vary.

Avoid irritating formulations if dry eye is a concern.

Final Thoughts:
Your concern about not being a candidate for revision or aggressive treatments is valid — but gentler, conservative treatments like silicone, steroid microinjections, and possibly microneedling may still provide meaningful improvement. The goal is to reduce volume and texture of the scar without compromising surrounding tissue or exacerbating symptoms.

Let me know if you have further questions or would like help tailoring an option based on product availability or skin sensitivity.

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented  scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. For a thick scar on the eyelid following upper blepharoplasty, CO2 laser resurfacing treatments can be an effective option. This procedure uses a focused laser beam to remove the outer layers of damaged skin, promoting collagen production and encouraging smoother, healthier skin to form. CO2 laser treatments can help reduce the thickness and appearance of scars, improving overall texture and tone. I use this all the time in our offices and highly recommend. I hope this helps and best of luck!

Thick scar eyelid post op 1 year upper bleph - what kind of treatment could you recommend? (Photo)

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