Hiding Eyelid Surgery Scar on the Crease?

Question

Can my eyelid scar be lowered so it will be in the crease? I had an Eyelid lift and the incision was not placed in the crease. You can see my scar with my eye open. I am wondering if anyone can fix this?

Kenneth D. Steinsapir, MD · Answer

Dear Tracy
This visible evidence of your eyelid surgery is caused by a couple of factors.  Please recognize that without a personal examination it is hard to know the actual cause of your particular issue.  
First, it looks like the design of the blepharoplasty excision (the shape of the skin that is actually removed by the eyelid surgery) was too flared laterally.  The evidence for this is the shape of the upper eyelid fold.  This fold should parallel the upper eyelid margin.  Instead beginning at the lateral edge of the pupil, the fold deviates upper ward making it look like someone (your surgeon) took an extra nibble out of the eyelid fold.  This curve is very gentle so care was exercised in the design of this excision but it was too much.
There is a little more going on here as well.  The skin on the eyelid platform is not firmly held.  There is a looseness to this skin.  Placing this skin on a slight stretch at the time of the blepharoplasty is very important because this skin supports the upper eyelid lashes and makes them look perky.  In order to create this tension, an anchor blepharoplasty must be artfully performed.  This involves cutting what will be the new upper eyelid crease height just right and sewing the cut edge of the eyelid platform skin and underlying muscle to the exposed levator aponeurosis-the upper eyelid tendon that lifts the eyelid open.  It is my observation that very few eyelid surgeons possess the skills to accomplish this.
Can your upper eyelid fold be lowered?  Unfortunately this is impossible.  The blepharoplasty needs to be carefully and thoughtfully revised.  This means cutting the upper eyelid fold so it is one continuous curve.  The left side will most likely also need to be revised to match.  This will effectively raise your eyelid fold.  However, in this photo, your eyelid margin looks low.  This is call upper eyelid ptosis.  At the time of revision, this ptosis can be addressed.  This would effectively shorten the upper eyelid platform and the overall result, I think would be much better than your current situation.
Obviously revising and fixing this situation requires highly advance cosmetic blepharoplasty skills.  There are probably only a dozen surgeon's in the world who possess the skills needed to improve this situation.
Dr. Steinsapir

Eric M. Joseph, MD · Answer

Dear Tracy,
I could give you better advice if you send me a picture with your eyes closed. That will show the scar in its entirety.
The scar looks fairly new, and it will likely get better with time. Most eyelid scars look like fine white lines in 6 to 12 mos., so don't sweat this one too much. Your surgeon may have put the scar in the wrong place, but it will improve, even if you do nothing. It doesn't seem like you had too much skin removed, so if is an eyesore in 6-12 mos., it may be fixable.
I hope this helps, and let me know if I could be of further assistance.
Best regards.

Benjamin C. Marcus, MD · Answer

Thanks for the picture.
This indeed can be fixed. It does depend on how much laxity you have left in the brow/lid complex.
You look fairly young so I think it shouldn't be a problem.
In your type of case I remove skin below the incision and advance the upper skin back down into the crease. This is a relatively small procedure and can usually be done in the clinic setting.
Your surgeon should offer to do this at no charge (I believe)
Hope that helps!

Jonathan Hoenig, MD · Answer

Is is posisible to lower your upper eyelid scar, but it is not always so easy. It depends on the laxity (looseness) of your scar both above and below the incision, as well as the amount of fat (or lack thereof).

	A better solution may be to laser the scar with a laser that will remove the redness, rendering the scar virtually undetectable without having to undergo another surgery. Of course, it goes without saying, you should be wearing sunscreen and practicing sun avoidance (hat and sunglasses) to prevent further darkening of the scar.

Chris Thiagarajah, MD · Answer

Looking at the photograph, it looks like it can be however 1. It has to be matched to the other side 2. Removing more skin to close the gap may cause your eye to have problems closing 3. nothing should be done before atleast 4 months. Most times an incision line like this will resolve almost imperceptibly. I would wait and see how it looks 4 months after surgery. If you were to have it fixed I would have someone who does blepharoplasty revision surgery perform the case. This person would have experience with this relatively uncommon problem.

William Portuese, MD · Answer

From the picture, it does appear that the eyelid incision is a little bit higher than normal, and this can be brought down and placed in the normal crease line. It is important to wait approximately three to four months before embarking on a revision eyelid surgery.

Brooke R. Seckel, MD, FACS (retired) · Answer

The scar was not placed in the supratarsal fold. It can be revised but it is somewhat complex and likely both eyes will need to be revised.
It appears from your photo that you have adequate excess skin left to allow excision of the scar and a supratarsal fixation suture to hold the scar into the crease or supratarsal fold, but you will need an expert exam to be certain.
I suggest that you see a board certified plastic surgeon who specializes in eyelid surgery

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