Lower Eyelid Surgery One Year Ago and I Have These Suture Marks (train Tracks) Scars Under my Eye? (photo)

Is there any procedure or cream I can use to get rid of these. I was thinking a chemical peel, but was told that is only very superficial, I was also told laser, but I'm afraid it would retract my eyes even more from the tightening. I also have ectropion and retraction too. What would help these scars and what should I stay away from? Also what caused this to happen? Thank You.

Doctor Answers 9

Train track scars lower eyelid

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You have a very bad outcome after a lower Blepharoplasty because you not only have unsightly scars from the incision and it's closure but you also have a pulled down lower eyelid with too much of the white of the eye showing(ectropion/ scleral show).  You should consult an experienced Oculoplastic surgeon, perhaps at the Iniversity of Michigan.  This is, to a large extent, correctable if done properly.

Problems following a lower eyelid blepharoplasty

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You are correct that you have lower eyelid retraction that may be due to over resection of skin or a pre-existing laxity of the lower eyelid.  The suture marks are and  unfortunate technical complication due to the sutures being left in place too long.  It is important to remove eyelid sutures in 5 -6 days to avoid this problem or place the sutures under the skin in the subcuticular level. Swelling can also place the sutures under more stress and create the hash mark scars.   You are correct a skin peel will be of no benefit and CO2 laser could cause you to have more skin retraction and scleral show.  Correction may include a revision of your lower eyelid blepharoplasty, support of your lower lateral canthal tendon with a cantholysis and canthopexy, support of the lateral cheek to take the stress off of your lower eyelid.  The track marks appear to be at least 5 mm wide and this precludes an excision of the scar.  It is possible that a skin graft using skin from the upper eyelid may be necessary.  At this point an examination with an experienced plastic surgeon or occuloplastic surgeon is needed.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Post-blepharoplasty scarring

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It appears that you have ectropion.  However, as to the scars, these are quite unusual and reflect both that sutures were left in too long and that they were placed with too much tension.  Please see a board certified plastic surgeon regarding revision. Best of luck.

Ectropion after lower lid surgery

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The retraction and ectropion seen in your photo can have several causes, however a common one is over resection of skin. Chemical peel and laser might make matters worse, so you should see your surgeon about correction.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Scarring after lower eyelid surgery

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Your scars underneath your eyelid appear significant.

You may want to consult a surgeon with considerable midface (cheek lift) experience who uses lasers on a daily basis for your options.

Your next step will be very critical.  Only select the very best at this point if you decide to have revisional work on your eyelids.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 195 reviews

Lower Eyelid Surgery Tracks

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The picture posted shows scleral show and cicatricial ectropion in addition to the very elongated suture tracks.  The photo appears to show a situation in which excessive skin was removed and therefore a higher than acceptable degree of tension was placed on the wound; these conditions are often associated with dry eyes and corneal irritation. Unacceptable lower eyelid scars are unusual in most experienced Surgeons hands.   I agree with Dr. Vilar that this condition has a high likelihood of becoming worse if not treated by a Surgeon well versed in treating challenging lower eyelid issues.  I recommend seeing an experienced Occuloplastic or Facial Plastic Surgeon for further evaluation.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 104 reviews

Ectropion and eyelid retraction should be addressed for eyelid health as these issues make it harder to address the suture marks

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Those suture marks are the result of having lower eyelid blepharoplasty done from the outside where an incision was made and skin was overlapped with stitches. When it healed, you developed these marks.

When someone has adequate skin, my approach in removing the stitch scars would be to excise the skin that has the marks or at least much of it as possible. Sometimes, we can improve this area with laser but because the skin is so thin, it’s a very tricky thing to consider given that you also have retraction and ectropion.

You’re dealing with an issue where there are multiple problems in terms of tissue availability. That means if your eyelid is rotated out, there can be a skin shortage so you need more skin. If it is retracted, then the middle layer of the skin needs some vertical height. So you might need more than just dealing with these suture marks, but this dependent on your perception of your cosmetic outcome as well as how aggressively you want to deal with the functional aspect. In ophthalmology, having eyelids that function well is critical for eye health. So it’s surprising to me that you are not concerned about symptoms related to tearing or dry eye.

Your concern about the mark is of course important but I think in the big picture, the position of your eyelid in relation to the health of your eye is a more significant and needs to be addressed. My suggestion is to consider a strategy to help address the eyelid retraction and ectropion. I would recommend visiting an oculofacial plastic surgeon with a lot of experience in this area particularly in the cosmetic area. I hope that was helpful, and thank you for your question.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Eyelid Scars

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Thank you for your question and photo. Unfortunately you have significant scarring on the skin surface and within the eyelid tissues. This is causing lid retraction and ectropion.  Lasers and chemical peels will not help and may be harmful.  I would recommend consultaiton with a Plastic Surgeon experienced in lower eyelid reconstructive procedures. You will need a canthoplasty with or wihtout a  cheek lift and lid spacer graft.  You may also benefit from skin grafting or flaps to improve the appearance of the skin. Best wishes on your recovery.


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Frankenstein or tract marks typically occur when sutures are too tight, left in too long, or get infected.  Some people just heal that way from genetics.  Your pre-op photos would be helpful, but it appears you have ectropion.  This typically occurs if too much skin is removed and/or if you develop a post operative hematoma.  This is a serious problem that could worsen in the wrong hands.  Seek a very very experienced plastic reconstructive surgeon, or very very experienced oculoplastic surgeon.  Keep your eye well lubricated until you get this fixed.  Your cornea is at risk.

Luis Villar, MD, FACS
West Palm Beach Plastic Surgeon
4.4 out of 5 stars 11 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.