Am I healing normally at 9.5 weeks post surgery for upper blepharoplasty? Full incisional (Photos)

I have gotten full incisional double eyelid surgery, removing fat/skin and also taking in the inner corners slightly, and it has been 9.5 weeks. I'm worried that my eyes are healing too slow and the crease on the inner corners are forming abnormally. I still experience pain on the inner corners and the scars (a stinging pain) occasionally. Are my eyes still considered swollen? Will my crease look more natural and become lower over time? And are my inner corner creases forming abnormally?

Doctor Answers 3

Based on your pictures alone, your rate of healing looks normal, and you should see close to final results in about 6 months

Thank you for your question. You have submitted several very good photos of different views of your eyes up close with your eyes closed. You are nine and a half weeks after undergoing Asian eyelid surgery in which skin and fat was removed, and you also had some work done in the inner corners (epicanthoplasty). You ask if this is normal healing ,and is there anything to be concerned about.

I can give you some guidance about how you are healing. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. I do a lot of Asian eyelid surgery in my practice, which is an area of specialty of mine for both primary and revision surgery. I can explain how I approach this type of procedure with my patients and what to expect over the several months to a year after surgery.

Based on your photos and without any physical examination, the overall appearance looks consistent with incisional surgery. Everything does look like normal healing from the photos. To understand what normal healing is, you have to take into account what is unique about Asian eyelid surgery. Asian eyelid surgery, whether it’s incisional or non-incisional, there is one critical element that has to be part of that surgery - a connection between the skin and the muscle underneath the skin in the eyelid called the levator muscle, which is the muscle that lifts the eyelid. When you are trying to create a crease, you’re creating a connection between the eyelid skin and this muscle.

In your situation, your doctor decided probably due to  extra skin and fat to do an incisional approach. When that surgery is done, the skin is stitched to the underlying muscle, so what you are seeing is some of the redness and swelling typical two months after surgery. I always explain to Asian eyelid surgery patients that the space between the eyelid crease and the margin can collect a lot of fluid, which creates the impression of the crease being higher. It can be a little challenging to see that pace in which the fluid is going away, but it is very typical.

I always tell my patients to expect swelling to be present up to a year. It doesn’t mean the same level of swelling; there is an improvement with time, but even at 3 months you can have a significant amount of swelling. You have to wait out until that swelling goes down before you see the final result. Typically, about 6 months there’s a more stable appearance of the eyes. Even though fluid can linger, especially with people who have sinus issues or allergies, that’s likely the time you can reasonably conclude that you’re where you should be.

It’s the same thing with epicanthoplasty, which is the repositioning of skin to reveal more space where the corner of the eyelid is. When you look at the skin, it’s the fold over that inner corner, the inner canthus is called the epicanthal fold. It’s understood there may be a little redness and swelling. The skin can look a little thick and bumpy, but that also is very normal.

There are several stages of wound healing and the first month is what’s called the proliferative stage. This is where the body’s producing a lot of collagen, a lot of blood supply to deal with this controlled healing process or controlled trauma of surgery. After that, it goes through the wound remodeling process when fluid diminishes. The collagen orientation becomes more parallel meaning the skin starts to become softer and flatter. When we see our patients, we reeducate them continuously about this process. We see our patients at 1 week, 1 month, 3 months, 6 months, then 12 months. During those visits, we have this discussion to help people understand this.

It is important to communicate continuously with your doctor. Make sure you bring a list of questions or bring to their attention your concerns, and get a sense of what to anticipate. It’s routine for me during consultations to show examples what the healing process is like so people have a better understanding. As a general rule, non-incisional swelling can still last a lot less or as long as incisional, but there are always exceptions to that. From a collegial standpoint, it looks like you’re healing as expected based on the photos alone, and make sure you follow your doctor’s instructions, and wait and see what the final result is. I hope that was helpful, I wish you the best of luck and thank you for your question.

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New York Oculoplastic Surgeon
4.3 out of 5 stars 72 reviews

9.5 weeks post op Asian eyelid surgery

I would say four 9 1/2 weeks postop from Asian blepharoplasty it looks a little bit tight but should continue to relax. You might want to consider some gentle massage of the eyelids and even steroid injections. Follow up closely with your surgeon and see what recommendations they may have. The appearance of the lashes and the white edge of the eyelid should keep relaxing as well. If it's very tight at the inner corners and very firm and tender to the touch at this stage then I would even more strongly consider a steroid  injection.

Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 76 reviews

2 months post-op Asian blepharoplasty

Your eyelids are still healing and the swelling will go down some more for sure.  You are not unusually swollen and it's pretty typical at this stage to have some residual swelling.  As for the inner corners, you may benefit from steroid injections and daily massaging of the scars.  By 6 months you will have a better idea what the final result would be like and if you need surgical revision to improve the appearance of your inner corners or not.  Hope that helps.

Goretti Ho Taghva, MD
Mission Viejo Plastic Surgeon
5.0 out of 5 stars 62 reviews

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