Will the Puckered Spot on Blepharoplasty Incision Resolve?

Question

I am one week post-op Asian upper blepharoplasty. I know it's too early but one of my incisions has a small puckered spot and next to this is a very small bump. I can feel it more than see it but it's causing a very slight gathering in the crease when I look straight ahead. My other crease is perfectly smooth. Will this resolve with time? Is there anything i can do to improve this during healing?

M. Christine Lee, MD · Answer

I agree with the others who responded that the puckering could be due to swelling which is very common after blepharoplasty. It's not unusual for one eye to look slightly different or better than the other because both eyes are not symmetrical to begin with. The incision site will continue to look better with time. You should follow-up with your surgeon who let you know if and when some intervention is needed. If there needs to be correction it would be best to wait until 3 months when you've had adequate time to heal. Doing something too soon could actually cause a problem where there might not be anything actually wrong.

Dennis J. Bang, MD · Answer

Anyone who has eyelid surgery will see and notice things more critically than ever before. Anything that doesn't appear to be normal would cause concern as being a complication or a problem. Almost always this is normal and it is a result of the time following surgery when you often regret your decision due to postoperative swelling, bruising, and discomfort. Compounded by to time spent focusing on one area of concern and the feeling of what have I done to myself. Asymmetry is also another concern which is common. We are all somewhat asymmetric and this seems magnified after surgery. Any difference between the two sides will improve with time and a common concern. Now is the time to relax and follow instructions. Your concerns are legitimate but any areas of concern almost always resolve with time. One week is early and you should see consistent improvement of your results from this point. Keeping your head elevated during the immediate postoperative period helps to reduce swelling as does cool packs during the first day or two. Do not disturb any sutures or excessively manipulate this area as this could cause harm. The bump may be related to a suture used to create the crease and if necessary a simple procedure should solve this issue. IF, it is necessary at a later time. The upper eyelid skin is remarkable in its ability to heal quickly. Just give it time and things should be great.

Carlo Rob Bernardino, MD · Answer

The puckering should resolve after the swelling resolves. Asian eyelids tend to take longer for swelling to resolve; blepharoplasty in a caucasian may have swelling for a few weeks whereas in some Asian patients it can last longer up to a month or two. However, a significant amount of swelling resolves within the first two weeks.

	Puckering is also dependent on how the deep suturing was performed to reform a lid crease. My technique for double eyelid surgery involves externalized sutures for lid crease formation. At one week these sutures are removed and therefore puckering is minimized.

Sam Goldberger, MD · Answer

At 1 week post-op, it is very early in the healing phase. Often swelling can be the cause of what you are describing. If the other side looks great as you describe, most likely symmetric surgery was done and this will resolve. If this is the case, you should see definite improvement in the next 2 weeks.

Chris Thiagarajah, MD · Answer

1 week out is early so you need a little time for this to improve. If it persists it can be excised or softened. First you need to give it a full 12 weeks to heal.

Philip Young, MD · Answer

The puckered area could be a local area of inflammation that will resolve with time and all of your worries will be alleviated. Sometimes these areas of swelling will lead to changes in your eyelid crease. Once the swelling goes away, the crease will improve. 
If you were to do anything right now the results of this could be disastrous. One mantra that consistently is passed between surgeons new and old is "the enemy of a good result is a perfect one." Meaning that there is a phenomenon when the more you do to improve a situation to perfect (which is unattainable) will sometimes reach a point that the more you do the worse it gets. This mantra would apply in this case.

Amiya Prasad, MD - Account Suspended · Answer

As you said, you're one week post-op. Whereas I completely understand a patient being nervous about any concept of imperfection after surgery, please remember that we do not heal overnight, nor do we heal evenly.
I do this procedure regularly. The puckering and small bump you refer to is not at all uncommon in the healing process of any upper lid Blepharoplasty. In your case, it may even be a bit more common as an Asian Blepharoplasty (creating a crease in the upper eyelid where there was none before) needs that extra securing in the stitching process to achieve the correct result.
I would be curious to hear about your results now. Whereas I can not speak to your case specifically, usually that puckering that you refer to resolves itself in less than a month. I know it is frustrating that one eye is so much better than the other. That is how our bodies heal themselves however. Rarely is it entirely even.
I am in hopes you are happy with your results!

Will the Puckered Spot on Blepharoplasty Incision Resolve?

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