Second Blepharoplasty Procedure - Scarring

Due to genetics I have always had heavy bags under my eyes. At 19 I had blepharoplasty with an interior incision. Now 12 years later, it was time for a redo, this time I opted for the exterior incision since it is a more permanent fix. I had the surgery yesterday. Post-op my doc said he found excessive scarring inside from the 1st surgery. Question: if I scarred heavily inside my lids from the 1st surgery, am I likely to scar excessively on the exterior? What can I do now to minimize this risk?

Doctor Answers 9

Scarring after Blepharoplasty

Please discuss with your surgeon what scarring he found and what recommendations he might offer to minimize the risk of "excessive" scarring in the future.

Denver Plastic Surgeon
4.6 out of 5 stars 39 reviews

Scarring after blepharoplasty

"Excessive scarring" could just mean that your surgeon had a tough time with his dissection, due to prior scar tissue.  That's just a reflection of how you healed and what was done in that initial surgery.  Internal scarring is not the same as external scarring, so I wouldn't equate those two and worry about what an external eyelid scar might look like.  Eyelids tend to scar very well, since the skin is quite thin.  Massage and time are your friends.

Carmen Kavali, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 42 reviews

Scarring and revision of lower eyelid surgery

For very young patients with lower eyelid bulges, the best solution is often transconjunctival removal of fat.

For patients with lower eyelid bulges and loose skin, the problem becomes more complex. 

How do we tighten the lower eyelid skin when it becomes loose?  Lower eyelid tightening procedures are complex and exacting.

Lasers are wonderful; we use them daily in and out of surgery.  However to the extent that the skin is tightened with a laser resurfacing, the eyelid will pull down. 

In our practice, we do not perform a conventional (subciliary) lower blepharoplasty in any patient, simply because it pulls down on the lower eyelid.  When a canthopexy alone is performed with a subciliary blepharoplasty, this can result in a severe uptick in the corner of the eye, so this is not in my opinion the best option for support of the lower eyelid if a lower blepharoplasty is performed.

In our practice, we typically do a skin tightening of the lower eyelid by means of elevation of the cheek through an ultrashort laterally based subciliary incision.  By elevating the cheek, we do not steal from the lower eyelid, causing it to change in shape to "sad" or "rounded" in appearance.

In older patients, the looseness of the lower eyelid also comes into play.  Does it need to be shortened?

Revisional lower eyelid procedures are quite complex.  Hopefully you had very conservative work and your surgeon can guide you through the postoperative care of your eyelids.  This may include injections, massage, taping, etc. all of which require close contact with your surgeon.

Several articles and book chapters are referenced below if you have extra time on your hands.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 177 reviews

Second Blepharoplasty Procedure - Scarring

Hi Sara.

The scarring that the Doctor found internally should not have much effect on the exterior scar.  However, the best answer will come from your surgeon.

Sam Goldberger, MD
Beverly Hills Oculoplastic Surgeon
4.7 out of 5 stars 16 reviews

Scarring Associated with Blepharoplasty

Revision lower lid surgery is generally associated with some degree of scarring.  Assuming appropriate suspension techniques were utilized by your Surgeon with your subciliary approach, it shouldn't affect your outcome.  However, as others have noted, the best person to seek advice from at this point is your Surgeon.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 93 reviews

Options to diminish lower lid scarring after secondary blepharoplasty.

Scarring or wound healing can be very exuberant at 19 and much less so at 31.  There are numerous factors that effect the degree of scar tissue that may be well beyond your control. Your surgeon may recommend a regimen which they have found useful.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

Scarring after a blepharoplasty


Scarring following a lower blepharoplasty should be minimal.  It is uncommon for this region to scar badly.  You surgeon may have encountered scarring beneath the skin, which is not unusual following nearly any surgery.  There is some evidence that silicone tape or gel can minimize hypertrophic scar formation, but I doubt it will be necessary her.  Good luck!

Jason Hess, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 11 reviews

Revision Lower Blepharolplasty and Scar Tissue

Hi Sara,

You shouldn't worry about scarring from your external lower eyelid incisions as long as your surgery was performed properly.  The "scarring" described by your surgeon refers to "scar tissue" that is fibrous tissue which occurs after previous surgery, making the dissection more difficult.  Hope that you love your new lids.  Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Second Blepharoplasty Procedure - Scarring

From your posted story I would advise to discuss this with the chosen operating surgeon. We, posters, were not there so the degree of scarring can not be determined. Best of luck from MIAMI Dr. Darryl J. Blinski, 305 598 0091

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.