Are these scars normal three weeks after lower blepharoplasty? (Photo)

Question

I had a lower blepharoplasty on November 28, 2016. Are these scars normal? I can't figure out why I have these scars extending out from the edge of my eyelids when I only had a lower done, not an upper. The scars are very noticeable and make me quite self conscious. From my research, I though the scars would only be right under the eyelid and would be minimal. Mine seem severe. Is there anything I can do?

Scott Trimas, MD · Answer

Your scars are more prominent; however, they will likely improve over time and not require any additional treatment. If you had an extended lower blepharoplasty, it is not uncommon to extend the scar near the orbital rim. In the worst case scenario, the scars can be improved with laser therapy. I would discuss your concerns with your surgeon.

Raffy Karamanoukian, MD, FACS · Answer

Plastic surgery scars require attention after surgery so that they remain cosmetically-appealing and barely noticeable. In our office, we use a protocol for scars that minimizes their activity in the 6-8 weeks after surgery. If you have late plastic surgery scars, you may also require laser and RF therapy to help reduce the longterm effects of the scarring. Keloids, hypertrophic scars, widened scars, red scars, and hyperpigmented scars all require scar modulation with topical creams followed by lasers and RF therapy. Topical skincare should be directed to a specific need, whether for pigmentation or hypertrophy and our office can guide you through the process to obtain the correct Plato’s Scar cream or Melarase cream for hypertrophy and discoloration. In terms of lasers, we would employ the vbeam laser for redness, Venus Viva RF, PRP microneedling, chemical peels, and Morpheus 8, fractional erbium, or fractional co2. All of these have their individual benefits. Most of all, we recommend you visit a solid plastic surgeon who understands surgical scar revision, laser therapy, and RF therapy for scars. 
 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Parker A. Velargo, MD, FACS · Answer

Depending on how much skin needed to be excised, it's not abnormal to have the incision extend beyond the lid limits. You are still early post-op, so the scars have a lot of maturing to do. Having said that, the scar on your right lid is slightly widened and may require a revision or resurfacing to improve its appearance down the line. Giving things time is the most important thing for now. Protection from the sun and a silicone based scar cream can help things along (e.g. Biocorneum). Hang in there!

Robert Graper, MD · Answer

I think the scars will get better and your surgeon will best advise you. Scar revision is easy but I would hold for at least three months.

Sean Freeman, MD · Answer

jws1977, I don't do skin muscle flap surgery (open lower lid blepharoplasty) anymore or perhaps I should say I rarely recommend this approach. Having said that if you chose this approach this is one of the risks you assume and it is way too early to panic. Stay with your doctor and follow their recommendations. If after 6 months to a year you are unhappy see an experienced specialist that does "only faces". Good luck!

Justin P. Martin, MD, FACS · Answer

Since you are only 3 weeks from surgery it is too early to commit to surgical scar revision, as the appearance of scars can improve as they soften and mature.  This scar maturation can take several months to a year to occur, and scar massage and silicone scar treatment can speed up this process.  If you are still not satisfied with their appearance after they have matured, revision could be considered at that time.

Sara A. Kaltreider, MD (retired) · Answer

Surgeons will give you differing opinions on where to place the incision lines for a transcutaneous (skin incision) blepharoplasty. Most surgeons these days perform a transconjunctival (conjunctival incision, behind the lid) unless the patient has a remarkable excess of skin. If the skin incisions are visible after surgery - and they usually are for at least a couple of months - you have options: 1) use over-the-counter scar preparations and give it time (2-4 months for the pink color to resolve, up to 6 months), 2) have the scars treated with laser after maximal healing (I have used CO2 ablative fraction for this and it works nicely), 3) have the incision lines revised at 6 months, 4) use concealer and wait it out. Don't be discouraged because you are still early in the healing process. Best wishes!

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