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

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.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

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

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.