How are these stitches invisible? (Photo)

Question

I am wanting to get upper blepharoplasty surgery and researching doctors. I am quite worried about the scar, and I’m concerned you will see it even when my eyes are open. I have seen some people where the scars are very long and protrude well past the eye, and in some cases even above it! I have found a doctor online who looks like she does super neat sutures, how is this possible? I can’t even see the sutures, and this is supposedly straight after the procedure. What is this technique please

Christopher David Jones, MBBS, BSc, FRCS (Plast) · Answer

The aim of upper eyelid blepharoplasty is to remove excess skin and/or fat and hide the scar in a natural skin crease. In the majority of patients, the scars are virtually impossible to see. There are different ways to close the wound after surgery. Frequently a running, subcuticular type stitch is used, which is removed between 5-7 days after surgery.

Jeffrey M. Darrow, MD · Answer

The markings for a blepharoplasty should be done using a caliper to very carefully measure the skin of the upper eyelid and then a careful pinch test should be done to determine the amount of loose skin that can safely be removed. A careful incision, meticulous hemostasis, and a running subcutaneous suture, where the entire suture is placed beneath the skin, will  give the best scar possible with minimal bruising. If the incision is placed correctly, the scar is never visible when your eyes are open as it sits exactly in the fold of your upper eyelid.  Ask your plastic surgeon whether this is possible.

Kenneth D. Steinsapir, MD · Answer

This may be the eyelid all cleaned up immediately after surgery but before the placement of sutures. It may be the eyelid after the removal of sutures such as a subcuticular stitch. The important thing to understand is that the closure of the blepharoplasty is important but not as important as the design and execution of the surgery including what precisely was perform internally in the eyelid. In my opinion the blepharoplasty represented in this photograph will only be mediocre at best. The crease is too high, the eyelid platform skin is lax so the eyelid will heal with lash ptosis and likely crepey eyelid platform skin. It is far too early to tell but these are early hall marks of what I call  post upper blepharoplasty syndrome.

Michelle Zweifler, MD · Answer

Blepharoplasty scars are usually placed in the natural upper eyelid crease.  Scars are pink for the first six months or more as the wound heals.  Longer scars outside the eyelid crease are performed if excess upper eyelid skin; a lateral brow lift may minimize the scar length.
The photo you are showing looks like a very early postop with swelling and still has purple marking pens applied; it looks like a running intracuticular closure with internal dissolving sutures.

Zoran Potparic, MD · Answer

The length of the scar will depend of how much skin needs to be removed. Incision may stay with the eyelid itself or, when needed, extended into crow feet areas. These scars are well hidden within upper eyelid crease and in most patients they heal favorably. Good luck.

Camille Cash, MD · Answer

The length of the incision is dependent on how much skin needs to be excised.  The scar should end up in the crease of the eye so that it is not visible when the eye is open.  These scars tend to heal very well and quite quickly.  Once makeup can be worn the incisions can be near impossible to see!  Visit with a board certified plastic surgeon to learn more.  Be sure to review before/after photos and don't be afraid to ask questions.

Mats Hagstrom, MD (license on probation) · Answer

There are many different quality ways of doing a skin approximation.
In the picture you provided either the sutures have been removed or the suture is a running intra-cuticular suture that goes below the skin surface so it can not be seen. These sutures still need to be removed and it’s not Necessarily a superior wave of closing eyelid incision.The length of the incision depends on how much skin is being removed.
If a significant segment of skin that needs to be removed, then the incision line needs to be much longer.
Different people need different approaches and it does not represent good or bad work.
Best,
Mats Hagstrom MD

How are these stitches invisible? (Photo)

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