Worried About Scarring & Natural Look if I Have Eyelid Surgery? (photo)

I'd like to have surgery to reduce saggy eyelids and the look of tiredness. I am very fair skinned and am worried about scarring. I had a breast reduction 10 years ago and have some keloid scarring. Will I be more prone to scar and if so, is there something I could do post-op to help myself achieve less scarring? Also, any recommendations for P.S. in either Minneapolis or Scottsdale, AZ? I want a very natural look w/ no brow lift, just the upper/lower lids. Thank You!

Doctor Answers 12

You are actually asking about several different issues here.

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First keloids.  It is likely that you developed a hypertrophic scar with your breast surgery rather than an actual keloid.  A hypertrophic scar is a rope scar that is confined to a surgical incision line.  These occur commonly on the torso because there is a great deal of tension on these woulds.  Eyelid skin is very thin and is brought together with virtually no tension.  Hypertrophic scaring is highly uncommon even with a history of hypertrophic scars on the torso.

Natural is a whole other kettle of fish.  If you ask 100 eyelid surgeons, they are all going to tell you that they do "natural surgery."  Unfortunately natural is a bit in the eye of the beholder.  The before and afters on a surgeon's website are probably much more revealing  than the assurance that they do "natural."  You picked a great after example of what you don't want with eyelid surgery.  Even though the surgeon left the eyelid with an upper eyelid fold, the eye looks skeletonized, the eyelid platform is not smooth, and the lateral aspects of the upper eyelid incisions are visible and irregular.  It is essential to understand that you need your upper eyelid fold.  The key is to expose just enough eyelid platform to that you have a smooth edge of upper eyelid platform onto which to apply makeup.  Another issue with your eyelids is the presence of upper eyelid margin ptosis.  The upper eyelid hangs low.  SImply excising skin without repairing the upper eyelid ptosis will give you the appearance of a very long upper eyelid platform.  Neither Scottsdale or Minneapolis are considered centers for excellent eyelid surgery.  That does not mean that you won't be able to find a thoughful eyelid surgeon.  It just means that you need to really do your homework.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Natural results from blepharoplasty

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You can benefit from upper and lower blepharoplasty, and possibly ptosis surgery. All can be performed together, under local or sedation anesthesia. For achieving natural results, see an oculoplastic surgeon. Less is more, especially for the lower eyelids.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

Eyelid skin heals great

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If all skin healed as well as eyelid skin we would all have nothing to complain about.  This skin is thin and has a great blood supply and rarely would you encounter hypertrophic or keloid scars in this area. 

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

Upper and lower blepharoplasty with a natural look.

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Upper and lower blepharoplasty with a natural look is achieved by choosing an experienced surgeon whose results look natural. In 35 years of doing blepharoplasty I have never had to revise an eyelid scar. The risk is very low. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Eyelid Surgery and Scarring

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Based on the photos you have here, it seems like you would be a good candidate for eyelid surgery to look more refreshed.  The incision for the upper eyelid surgery is placed directly in the crease so that there is really not visible (it is placed in your anatomic crease that you see now when you close your eyes)  While keloiding is always possible, it is extremely rare in this area.  Please  consult with a board certified specialist who can assist you with achieving the results you seek.

Kimberly Lee, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Facial skin heals better than skin on other parts of the body, so eyelid surgery does have a physiological advantage

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In our practice, we do a lot of breast surgery. When we do breast augmentation through a transaxillary approach, and using local anesthesia with LITE IV sedation. Incisions are made around the nipple or in vertical incisions along the breast. However,  when we talk about skin healing, there is a real difference between the chest skin and the face. The face heals better compared to the chest because of the concentration of oil glands in the area that are necessary for healing.

In 20 years of practicing and treating people from different ethnic backgrounds, I wrote an article years ago called “Ethnic Considerations in Eyelid Surgery”. I can share with you that light-skin people tend to have very nice healing. Incision lines can be done in such a way that it’s almost imperceptible for someone to see the scars. A lot of hairdressers in my area in Manhattan and Garden City like to refer me because they like the way I do my incisions.

There are so many ways in taking extra skin in the upper eyelids. Patterns are drawn in terms of the technical aspect of removing the skin or whatever deeper structural procedures such as the removal of fat, adjusting a muscle and the closure of the incision. All of these factors affect the outcome of the surgery. With your skin type, there is a lot of room for flexibility and you’ll heal pretty nicely. Even in patients from an African origin who have a tendency to form keloids, they heal with no problem at all.

You should remember that how much skin is removed, where to put the crease, the closure, the after care and all the steps beyond that make a difference. I recommend that you meet with several experienced cosmetic surgeons who do a lot of eyelid surgery. A surgeon who knows the art of eyelid surgery will know the right plan for you.  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

Healing and Scarring after Eyelid Surgery

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Generally, eyelid incisions heal very well, without keloids. Some breast reduction scars are more prone to keloids, so your concern is understandable. Be sure that your plastic surgeon evaluates your current scars to determine if you are at increased risk for unusual scarring. Sun avoidance post-op is also helpful, so maybe you should think about Minneapolis instead of Scottsdale! Get a good recommendation for your plastic surgeon from friends or local physicians. By the way, I love the natural look and think that brow lifts are sometimes done too soon when an eyelid lift alone will suffice. Good luck!

James N. Romanelli, MD, FACS
Long Island Plastic Surgeon
4.4 out of 5 stars 25 reviews

Cosmetic eyelid surgery for tired eyes

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 The Primary goal of upper eyelid surgery is to remove excess skin and little but of fat creating the puffiness. The incision is placed in the crease of the upper lid and is faded out into the crows feet laterally.   The eyelid tissues heal much better than other parts of the body since the  skin is much thinner. We have never seen a keloid of the upper lids.  For best results on healing, its important not to get the upper eyelid closure too tight since the skin along the  incision line will have a tendency to pull apart, and give a wide scar.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Eyelid Surgery with Minimal Scarring

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The eyes are the windows to the soul. All too often, however, they seem to reveal exhaustion. The very delicate skin around the eyes tends to get crepey and puffy due to fatigue and stress. Eyelid surgery has become one of my most popular procedures. If excess upper eyelid skin is hooding the eye and needs to be eliminated, an incision is made in the crease at the top of the lid and excess fat and skin are removed. The incisions are closed and sutured on the underside of the skin. If undereye puffiness and dark circles need to be eliminated, an incision is made along the lower lashes that will be almost invisible when it heals. Next, the fat below is either removed or redistributed and the saggy and crepey excess skin is then pulled up and cut off. The incisions is closed with tiny sutures, which are removed in four to six days.

Michelle Copeland, MD, DMD
New York Plastic Surgeon
4.6 out of 5 stars 10 reviews

Natural Results with Minimal Scar in Eyelid Surgery

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Fortunately, even in someone who scars poorly elsewhere, the eyelids usually heal with almost no visible scar. Additionally, the scars are placed where they are mostly hidden. When done properly by an experienced blepharoplasty surgeon, the results are quite natural and simply make you look more rested and youthful. Ask whether the plastic surgeon you see removes fat as a standard part of the procedure. Modern blepharoplasty that not only results in the most natural initial results but maintains that natural look for many years generally removes no or very little fat from either the upper or lower eyelid. When fat is removed, you tend to look deficient around the eyes very quickly after surgery.


Robert T. Buchanan, MD
Highlands Plastic Surgeon

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.