Why is my eyelid not folding properly after double eye-lid surgery? (photo)

It has been almost 7 weeks since surgery so I strongly believe it is more than a matter of swelling. My right eye is not folding along the stitch line but the left eye is okay. It folds properly where the stitches were. What is wrong with my right eye? Does it seem like I need a reoperation? What are your thoughts? thanks

Doctor Answers 4

It takes time to see the final results of double eyelid surgery

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With double eyelid surgery, it's important to be patient to see the final results. Seven weeks is too soon to see the end result. Complete healing will take months, so the whole process is more like a marathon than a sprint to the finish line. You should be quite satisfied with your results in the long run. Remember too that each person heals differently based on various factors. If you are concerned though, consult the surgeon who performed your surgery.

7 weeks postop Asian blepharoplasty

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There appears to be more swelling on the right than the left and this may contribute to the issues you ignore with the crease on the right. Give your self more time to heal but discuss your concerns with your surgeon.

Suzanne Kim Doud Galli, MD, PhD, FACS
Washington Facial Plastic Surgeon

Recovery after Asian blepharoplasty

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Crease failure is possible after Asian eyelid surgery, and can occur from 5-10% of the time after surgery, depending on the technique.  That being said, give your eyes at least 6 months to heal before assessing the need for a revision procedure.  Follow up closely with your surgeon to ensure the best result.  He/she may suggest some measures to help proper crease formation.  

Donald B. Yoo, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 60 reviews

After 7 weeks you still have temporary swelling from surgery. I advise not attempting any revision until swelling subsides

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When evaluating the stability of the eyelid crease, it is important to understand that there are many dynamics in the outcome of this type of surgery. When you are the 7-week point, there is still some degree of swelling which may not always be apparent. The process of fluid absorption related to surgery happens not only at the superficial level like in the eyelash or eyelid margin or the crease, but also in the deeper levels of the tissue underneath the skin. There is a lot of healing going on and the healing process has several stages. True healing goes on for months and can take up to a year to settle.

If your doctor feels that the eyelid is still swollen, then any further enhancement surgery is not likely beneficial. I always explain to my patients that swelling changes the dynamics of the predictability of how you place the tissue when doing surgery. Unless there is a specific indication that requires earlier treatment, then it is usually best to allow swelling to resolve to a reasonable level, to the point the surgeon feels comfortable about going in and doing something to revise the result. I have seen patients who came in for revision surgery who had several surgeries done in a very short time frame, with the doctor trying their best efforts trying to make the patient happy. Unfortunately, with every trauma there is the potential of scar tissue formation and other issues. More importantly, swelling is a moving target and therefore it changes the dynamic.

If there are multiple folds and if the crease is not well delineated, it’s usually something that is amenable with a procedure such as a non-incisional fixation. Little openings are made and a connection between the eyelid and the levator muscle is created. A principle of most eyelid crease surgeries is to create a connection between the skin and levator muscle. If there is fat in the way of the space, then the fat is reduced or shifted out of the way in order to create the connection. However, when the sutures are removed, there is a possibility that the skin can detach a little and does not create the crisp, nice-looking fold.

My advice is not to lose hope and continue communicating with your doctor. I’m sure your doctor will see you at regular visits. In our practice, we see our patients at 1, 3 and 6 months and beyond and the doors are always open if they have questions or concerns at any time. Once you have this continuous dialogue and observation, and if your doctor takes photos and documents the progress, it might be easier for you to see where things are going. Surgical healing can take up to a year and swelling can be a factor. I hope that was helpful, I wish you the best of luck, and thank you for your question.

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