Hypertrophic scar after Asian eyelid surgery. Will it flatten? (Photo)

It has been 5 months after my asian eyelid surgery and my scar is still lumpy and bumpy, the hypertrophic scar didn't disappear. I have steroid injection and silicon gel, but it still lumpy and didn't flatten completely. I am worried that it will not flatten. Will it flatten? Any other treatment that will help my scar? Will picosure laser help?

Doctor Answers 5

Your scar can still flatten with time from normal movement like blinking, but there are treatment options that can also help

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Thank you for your question. You are 5 months after Asian eyelid surgery, and with your eyes closed you showed an area of scarring you refer to as hypertrophic scar. You’ve undergone steroid injection as well as silicone sheet, and ask if there are any other options, and mention specifically the PicoSure laser.

I can give you my perspective on a situation like yours. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years. I do specialize in Asian eyelid surgery among other eyelid specialty areas I do, and I can share my approach for people healing from this type of surgery.

It is important to understand that healing after eyelid surgery can take up to a year and even longer for true surgical healing. 5 months may be fine in terms of cosmetic appearance when your eyes are open and can look pretty good. As far as the scars are concerned, you underwent steroid injection but there is still a lot of maturing and healing going on. Often a scar like this which is red, getting thicker, or continuously increasing in size will soften over time. This is being offered without a physical examination, often just normal blinking can soften the scars. Yes, steroid injection can help and depending on your surgeon’s sense of appropriateness of the steroid injection, it is very important that you continue to follow your surgeon’s guidance.

The general approach in my practice is to be conservative and observe. It is extremely rare to have an undesirable thickened scar long-term. When you think about this type of surgery, the scar is in a place where the stitches were, so what caused the scarring to occur? As you transition towards the nose, the nasal skin which is a little thicker, can also cause the scar to appear a little thicker. Generally, the other factors contributing to a thickened scar, such as excess tension, are not really an issue with Asian eyelid surgery because you always have to leave enough skin to fold over. That said, you have to think for yourself how does the scar look compared to a month before - does it look better or does it look worse? That’s what guides a physician on what to do moving forward.

As for the type of laser procedure, be it PicoSure or any other, you’re probably thinking whether a laser is appropriate in scar management. Basically, there are two important phases - when it is early when the scar has a lot of redness, certain dye lasers are attracted to red have some potential value. In later phases, a laser may have value in planing down the scar or reducing it. However, I really don’t think a laser has any role in this type of situation, and won’t be beneficial. You may be creating a situation that can result in more scars. In my experience, this is a kind of situation where you observe and allow the full healing to occur. If the scar is still problematic, you can do surgical revision or strategic injection of steroid when appropriate. When there is any sign of the improvement occurring as the months go on, I think most of my colleagues would agree to just observe.

Discuss this with your doctor.  Hopefully you understand from what I discussed some of the factors on how a surgeon deals with this type of scar. I hope that was helpful, I wish you the best of luck and thank you for your question.

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New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Hypertrophic scars after Asian eyelid surgery in young patients

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I can't tell for sure but based on your photograph you look relatively young. Under the age of 30. Probably a lot younger. Young skin tends to be a little more reactive and if you naturally have relatively sick oily skin I've noticed that that's associated with a more vigorous inflammatory response after surgery. Five months is a long time what I would suggest is stopping to silicone or scar gel and just clean it normally and moisturize I don't know.  I've found that using gels and ointments for scar treatment sometimes prolong redness and irritation.

less is more and time usually takes care of it.

Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 80 reviews

Hypertrophic scars after Asian eyelid surgery

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In general, hypertrophic scars are rare after Asian eyelid surgery. However, if you develop one, some of the treatment options include revision surgery, steroid injection, scar gel, laser( I personally don't recommend this) and observation until the healing is completed. Healing usually takes minimum of one year.

Eric In Choe, MD
New York Plastic Surgeon
4.6 out of 5 stars 51 reviews

Upper blepharoplasty scar

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Surgical scars can often take 12-18 months to mature fully, so some bumpiness at 5 months can be expected. If you are already 5 months out and still have redness, a mild steroid cream should help reduce residual inflammation and help the healing process.

Mitesh Kapadia, MD, PhD
Boston Oculoplastic Surgeon
4.9 out of 5 stars 182 reviews

Hypertrophic Scar

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I would suggest continued treatment of the scar.  I would consider laser treatment and a full evaluation by an oculiplastic surgeon who may be able to offer other treatment options.  Good Luck.

Jessica Lattman, MD
New York Oculoplastic Surgeon
4.7 out of 5 stars 28 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.