Scars too high. Should I be worried? (Photo)

Question

I am 8 days out from upper bleph and I'm freaking out that the scars are too high. My doc said they would lower into the crease but I'm really worried. Thank you

Kenneth D. Steinsapir, MD · Answer

Before I go further, it is important to understand that while I think your surgery is not acceptable, I think many eyelid surgeons would not think what was done here is wrong.  I am in the business of fixing unsatisfactory eyelid surgery.  I know that you will be very unhappy with this surgery.  Does that make it malpractice?  I don't think so because many, many surgeons do exactly this type of work and, yes, it is awful.  
Not only is your upper blepharoplasty incision too high which means the crease is too high. The surgery appears to have also be causing a disinsertion of the levator aponeurosis, the tendon that opens the eyelids.  You have a compensatory eyebrow elevation you are going to heal with upper eyelid lash ptosis.  
The bad new is that this will not fix itself and I guarantee you that your current surgeon who created this will not know how to fix it or they would not have caused the issue in the first place.  You are fixable, and that is good.  These eyelids do need to heal for several months before revisional work is performed.  What is done is a new crease incision is make at the correct height, in your case that will be at about 7.5 mm above the eyelashes.  The disinherited tendon needs to be repositioned into this location on the tarsus to correct the upper eyelid ptosis.  Orbital fat that is bound down in the internal blepharoplasty scar is mobilize and brought forward to provide volume back into the upper eyelid fold.  With the correction of the upper eyelid ptosis, the eyebrows will relax down which will help soften what will be a harsh post-surgical appearance.  An anchor blepharoplasty forms a hard crease that supports the upper eyelid lashes.  The net result is generally an outcome that really does accomplish what was sought with the original surgery.
See my video to see how this is actually performed on a patient.  Note the video shows images from surgery so not for the squeamish.

Matthias Solomon, MD · Answer

The scar will NOT settle into the crease; However, with time it will fade away and it will not look as prominent.

Andrew Campbell, MD · Answer

The scars are a little high and will most likely not descend into the crease over time. The good news is that as the scar matures it will most likely become so inconspicuous as to be difficult to see. If that is the case, then the scar won't be an issue. The only other option would be to consider revision surgery if the scar is still a problem in the future. I would recommend giving it six months before considering further surgery.Andrew Campbell, M.D.Facial Rejuvenation SpecialistQuintessa Aesthetic Centers

Ross A. Clevens, MD, FACS · Answer

Thank you for your question. Eyelid surgery is virtually painless and recovery is typically quick. After a week or two, the area will be smoother and the surrounding areas will look more alert and youthful. I suggest that you review your post op care instructions with your board certified facial plastic surgeon.
Best wishes,

Bradford A. Bader, MD · Answer

It looks like the incision was placed above your natural eyelid crease. The shape of the incision is a uniform arch rather than the more aesthetically pleasing sinusoidal or lazy-s shape. In my opinion, the scar will not settle into the natural crease. I think revision surgery will be necessary for you to be happy with the result. I recommend seeking an opinion from a different surgeon on how best to correct the problem. Best of luck.

Sara A. Kaltreider, MD (retired) · Answer

The incisions are too high - this can be corrected after healing. I would recommend waiting 4-6 months and seeking consultation with a surgeon who is well-known for eyelid surgery. Oculoplastic specialists spend more time in the periocular area than other surgeons and are familiar with delicate lid crease anatomy, levator muscles, septal attachments, and repairs of blepharoplasties such as this. They are also adept at fixing or anchoring the eyelid crease in an appropriate position. You could go ahead with an evaluation with an expert, and this will reassure you. Be sure to select a surgeon you can trust with this revision - this may take more than one consultation - but that is far better in the long run than having bad surgery a second time. In the meantime, use concealer, eyeliner and mascara to disguise and distract from the abnormally high incision. When you look straight ahead, the incision lines will not show as much as when you look down or close the eyelids. Best wishes.

Scars too high. Should I be worried? (Photo)

Answers (6)

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