Can my double eyelid creases turn out even, even if the incision lines look different? (photos)

I had an Asian Blepharoplasty, and I am almost 3 weeks post op. From day 1, I could see the incision line, or stitching, on both eyes we're not matching. I know swelling will need to subside before final results can be seen. I just wanted some reassurance (or be mentally prepared) for what to expect. Can/will my creases still turn out looking even?

Doctor Answers 6

Uneven incisions. Is this ok?

I perform Asian eyelid surgery almost every day that I operate.  About one third of the cases that I perform are for asymmetry to begin with. So it is common for me to make the incisions and planning for each I've slightly different.  I don't know if this was the plan for you or your asymmetric to begin with but you will likely heal nicely. It's definitely too early to tell. I would follow up closely with your surgeon and if there are some minor to moderate asymmetries after you recover from your Asian eyelid surgery touchups or revisions are usually possible. You definitely need to communicate with your surgeon directly. Just keep in mind almost everyone looks a little uneven when they're healing. I wouldn't consider your healing process finished for at least nine months. If there're very obvious issues with in the first 3 to 6 months then that might be the appropriate time to discuss any future revision work with your surgeon.

Chase Lay, MD

Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 75 reviews

Eyelid Surgery

Hello and thank you for your questions. As you are aware, it is still too soon to tell since it has only been 3 weeks postoperative. But from the photos you provided, so far your eyes are looking good. I suggest following up with your surgeon if you are still concerned. I wish you the best of luck!

Peter Newen, MD
Orange County Plastic Surgeon
4.5 out of 5 stars 31 reviews

The incision lines are not necessarily where the eyelid crease finally forms - you have time to heal before the crease forms

Thank you for your question. I understand you had Asian eyelid blepharoplasty done about three weeks prior, and you’d like to know if your creases will turn out looking even, even when your incision lines don’t look symmetrical. To give you a little about my background — I am a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. I think I can certainly give you some perspective on this matter, since Asian eyelid surgery in particular is an area of specialty.

I understand your concerns as it is natural for a patient to look at their incisions and wonder if the future is going to be as asymmetric as the present. To clarify, the goal of eyelid surgery, whether it is incisional or non-incisional, is to create a connection between the skin and the levator muscle. The levator muscle is responsible for lifting the eyelid when you blink; and people who are born with natural eyelid creases have a strong and well-defined connection between these two aspects.

Assuming that your procedure involved the removal of skin, there will probably be some difference in the amount of skin that was removed in each eyelid, the anchoring, and the consequent swelling. What I try to explain to my patients, particularly those who come for revision eyelid surgery, is that the crease placement by incision does not necessarily correspond to the ultimate crease of the eyelid. This means that the crease will not necessarily form exactly where the incision was placed. This applies to Asian and non-Asian eyelid surgery. Rest assured you can be confident that your surgeon’s intentions or plans will work out as best expected.

Keep in mind that during surgery, there will be some variability. During the first month after surgery, the distance between the eyelid crease and the lashes is going to look extremely elevated due to swelling. The eyelid platform, or the area where eye shadow is typically applied, will look elongated or widened, and artificially high. However, over time, the swelling will retreat and equilibrium and balance will take over.

It is important to understand we are creatures of evolution, and this is the evolutionary process of healing. Wound healing is made up of different stages — the hemostatic stage, the inflammatory stage, the proliferative stage, and the remodeling stage. There will certainly be some fluctuation and variability during the stages, particularly during the first month. Again, wound healing is a process, and you’ll find that as the incisions fade, the exact placement of the incision becomes less important. People just often tend to overanalyze and get really critical about how the skin is stitched and how swollen the area is during the healing process.

I do think, however, that this question should also be directly addressed to your surgeon. It is likely that you chose your surgeon based on your understanding that the surgeon is experienced with Asian eyelid surgery, and if you pose this question to them, they may respond by saying that there may have been some degree of asymmetry in the level of fixation and crease height, in order to create the type of fold that is aesthetically and functionally most optimal for your eyes. Nevertheless, this is definitely a discussion that you should have with your surgeon.

In our practice, we follow up with our patients at one week, one month, three months, six months, and 12 months. For patients who have had Asian eyelid surgery, I will ask them to follow up after the first week. After the sutures are removed, I will follow up with them monthly in order to guide them through the healing process so they are assured things are going as planned. I suggest that you talk to your doctor and wait it out a bit more to see how everything heals up, and then move strategically from there.

I hope that was helpful and I wish you the best of luck!

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Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 70 reviews

Uneven eyelids at 3 weeks post Asian double eyelid surgery

Thank you for sharing your question and posting your photographs. There is a very good chance that your eyelids will look perfectly symmetrical in a few months. Allow more time to pass before judging results. I hope this house. Good luck, 

James R. Gordon, MD, FACS, FAAO
New York Oculoplastic Surgeon
5.0 out of 5 stars 140 reviews

Uneven double eyelid crease less than a month after the surgery

There are many times when the results are uneven right after surgery. So waiting is important. This may all even out. If you go in sometimes too early this could make things worse. I would wait at least 3 months. If it starts getting better it may be better to wait a little while longer and see what the outcome could be.

Philip Young, MD
Bellevue Facial Plastic Surgeon
4.2 out of 5 stars 84 reviews

Swelling and Asymmetry after Asian Double Eyelid Surgery

Dear tlby03~

Thank you for sharing your photographs. After double eyelid surgery, it is normal for the eyelids to remain swollen for several months. Sometimes, the eyelids are asymmetrically swollen and the difference resolves with time. In your photographs, you still have a significant amount of swelling. Although it is possible that there may still be some asymmetry after the swelling resolves, it's really too early to tell.  Though easier said than done, it's best to try not to focus on them too much until the healing is complete.

Best wishes for your recovery!

Amy Hsu

Amy K. Hsu, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 9 reviews

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