Upper and Lower Eyes Surgery, Day 18: The deep scars are my concern (Photo)

I had the procedure done 18 days ago. My left side scars are deeper than the right ones. Will the scars vanished? I have been prescribed Dermatrix Ultra.

Doctor Answers 4

Extended Infrabrow Excision Blepharoplasty

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Hi Falee,

The incisions on both the upper and lower eyelids do appear slightly indented.  If you showed the right side for comparison, we can see how the surgeon had wanted the incisions to look.  The redness will fade over time, although in Asian skin, the redness can take longer to fade than Caucasian skin.

The type of upper eyelid surgery that you had performed is called an Extended Infrabrow Excision Blepharoplasty (IBEB.)  It was first described in our literature by Sugimoto in 1991.  You can Google an article by Akihiro Ichinose, MD, PhD in Arch Facial Plast Surg. 2011;13(5):327-331.  Warning: there are explicit surgical photos of the surgery, but there are also explanations of the designing of the incision placement as well as before and after photos of how the incision heals over time.  I inserted the link to the article in the web reference below.

I have not performed the IBEB procedure, but I did consult with an Asian patient who had hooding of the upper eyelids, but did not want to change the upper eyelid fold.  I remembered seeing this article in our Facial Plastics Archives, and I showed him this interesting technique which would leave his eyelid fold untouched.  Since he was consulting with me from Asia, I suggested that he contact the surgeons who wrote the article for an opinion, and if he felt comfortable with the surgeons that he have the procedure with them.  In the article, they state that it is a good procedure for middle aged and older Asian women.  Since women are able to apply make up, this can help during the recovery process.  For men, I was not sure if the author's of the article would still recommend the procedure to my male patient, so I wanted him to speak to them directly. The article goes more into the Pro's and Con's of the procedure as well as some of the techniques they recommend in hiding the incision within the brow.  Once the incision is on the temple, the suturing of the skin edge becomes particularly important.  

Although Western surgeons are not intimately familiar with your surgical technique, it does not mean that it is wrong.  I happen to recognize the incision, and didn't want the readers and you to think that your Asian surgeon did something wrong, just because commenting surgeons were not familiar with the IBEB.  Many of the pioneering techniques especially for Asian plastic surgery are coming from Asian in particular Korean.  In this case, the technique is originating from Japan.  

Making the incision along the upper eyelid crease is a great way to hide the upper eyelid incision.  However, in the case of the IBEB type of incision the reason for this incision is to not touch the natural upper eyelid crease.  By extending the incision past the brow, an opening of the outer corner of the eye, but without actually lifting the eyebrow, which can create a quizzical or surprised look.  Special cases for using the IBEB is for Asian patients who had a very small double eyelid or even a single eyelid, but have redundant or "extra" upper eyelid/brow skin. 

If the incision does not heal to your satisfaction on the left side, but the right side heals well.  It is possible for your surgeon to perform a minor scar revision under local anesthesia, remove the indented scar and sew the incision again to make it flatter.  If your surgeon can make the right side look good, then you should be confident that the capability to sew this incision as flat as possible.

I hope this helps and reassures you.


Dr. Yang

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New York Facial Plastic Surgeon
4.8 out of 5 stars 33 reviews

Unusual scar

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I have never seen an upper blepharoplasty scar in the position seen in the photo. It is impossible to comment without seeing your preops and perhaps there is a reason for this. All scars in this region will improve with time and it is likely to settle with massage. Silicone gel can also help. Make sure to apply SPF on the scar in the sun. Laser can occasionally be applied to this scar but at 18 days post op the scar is doing well. 

Eyelid scars

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This is an unusual scar for eyelid surgery as most traditional upper eyelid lifts are done in the crease. I would be very interested in seeing the result in a year. The approach that the surgeon used is novel and somewhat suggestive of the direct browlift which is done just above the eyebrow. The problem with the direct lift is the visible scar which is frequently unacceptable. At eighteen days the scar is very immature and will improve considerably. Massage, and even laser treatent might help to improve faster. The eyelid itself is very nice. Asian skin is very prone to hyperpigmentation so be cautious with any treatment, especially laser, use sun screen and give it time.

Scars after upper and lower eyelid surgery

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After examining your photo, I am not at all familiar with the incision that was used to perform your upper eyelid surgery.  In most cases when upper eyelid surgery is done, the incision is placed in the upper eyelid crease.  Since your surgery was 18 days ago, the scars you have now should improve with more time but it is impossible to know how much more.  Sun protection is important in the healing process, so be sure to do that.  I would wait at least 6 months from the time of your surgery to evaluate your scars.  It could even take 12 months to see the final result.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

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