Risk of Lower Lid Scarring/Keloiding (African American)

I'm African American, do I have to worry about the lower lid scarring/keloiding. I'm considering lower lid blepharplasty.

Doctor Answers 9

No risk of keloiding after lower lid blepharoplasty for African American

The transconjunctival approach will completely alleviate any issues regarding keloid scaring. This is a procedure where the lower eyelid fat is removed from the inside of the lower lids and it would be impossible to have a keloid develop there. If there is excess skin, then a small incision is made at the outside along the lash line for excess skin removal. We have never seen a keloid in this area after performing thousands of cosmetic lower eyelid surgeries.  

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Lower Eyelid Surgery and Keloids...

I have performed hundreds of lower eyelid blepharoplasty on Asians and African-American patients, I still have to see keloid formation. The reason is that the lower eyelid skin is different (the collagen is different) from the skin of the rest of the body. The incision for a lower blepharoplasty is either inside the lid (what we call transconjunctival) or outside below the eyelashes margin. In the first case (inside the eyelid) the scar won't show and in the second case (under the eyelashes) the scar will fade very quickly. The main risk is that if the incision extend laterally toward the crow's feet, then the scar can be visible. 

Henri P. Gaboriau, MD 

Henri P. Gaboriau, MD, FACS
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

Risk of Facial Scarring with Blepharoplasty in African-American

Hi Oakland in Oakland, CA,

Keloid scars typically involve the ears, neck, and chest of darker skinned patients. Keloids are thick scars that grow beyond the boundary of the initial surgery, trauma, or ear piercing. Keloid scars treatment typically includes steroid injections and plastic surgery. Despite treatment, keloids have a relatively high recurrence rate.

Any procedure will create a scar. Howerver, scars from elective plastic surgery are generally not noticeable. Keloid scars, for whatever unknown reason, generally do not form in the central face, eyelids, or nose. For some patients, external eyelid scar can be avoided by performing a lower lid blepharoplasty via a transconjunctival or internal eyelid approach.

Only after a comprehensive evaluation can a eyelid plastic surgeon help determine appropriate options for you. Best of luck.

Dr. Chaboki

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 85 reviews

Risk of Lower Lid Scarring/Keloiding (African American)

This is a risk that should be discussed in detail with your chosen operating surgeon. I might consider the transconjunctival approach. Good luck.

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Lower lid scarring and keloid

It is extremely rare to get a keloid scar on the lower lids, but it could happen.  I would be very careful about pursuing surgery.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Have never seen keloids from blepharoplasty

For some reason, keloids generally do not form in the central face, so I think your chance of keloid formation is slim.  In addition, darker skin generally does not have the creepiness that lighter skin does, so most likely you do not need any skin removed from your lower lid.That said, the incision for your surgery can probably be done through the inner surface of the lower lid, and there is no risk of keloid formation with that incision.

Theda C. Kontis, MD
Baltimore Facial Plastic Surgeon
5.0 out of 5 stars 39 reviews

LId scarring yes. Keloid no unless you have a history of keloids.

The potential for unsatisfactory healing is real with every surgery performed.  For this reason, many lower eyelid surgeries specifically avoid cutting the lower eyelid skin.  Instead surgery is performed behind the lower eyelid.   Discuss these options carefully with your potential surgeon.  Also lower eyelid fillers can be an excellent alternative to lower eyelid surgery.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Bad scarring is rare in blepharoplasty (eyelid surgery)

There are two ways to do lower eyelid surgery.  One is done from the inside of the eyelid and there is no skin incision at all.  In that case there is no chance of eyelid skin scarring.  The other way involves a skin incision.  Your surgeon will let you know which way is best for your particular problem.  If your surgery requires a skin incision there is always a chance that there could be a scar (this is, as you know, more common in African Americans).  However, the eyelid skin is very thin and is much less likely to scar than other parts of your face.  The chance of scarring increases if the incision is carried out outside of the orbital rim (the bony rim that surrounds your eye).  Your surgeon will be able to tell you if you will have an incision in that area.

The bottom line is that cosmetic eyelid surgery is commonly done in African Americans, and significant scarring is very rare.

Marc Cohen, MD
Philadelphia Oculoplastic Surgeon
4.8 out of 5 stars 24 reviews

Lower Lid surgery and Keloids

Keloids are an abnormal, histologicaly distinct wound healing response marked by the growth of  scar tissue beyond the boundaries of the wound, as opposed to a hypertrophic or wide scar.  Keloids are more likely to occur on patients of African, Asian, and south American descent.  The most common locations for keloids are the sternum, deltoid area, and earlobes.  Eyelid skin is the thinnest in the human body and keloids do not form in this region.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 93 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.