Asian eyelid surgery 7 weeks ago - Scar developed at inner corners, making the crease height too high. (Photos)

Thank you for your question.You submitted several photos, and state you underwent Asian eyelid surgery seven weeks earlier. You have a series of questions regarding the current status of your healing process: First, you state you had some steroid injections done which resulted in making the eyes more red; you wonder whether it’s necessary to keep doing those steroid injections; you mention the crease appears to be too high, and ask if it will go down; you say your eyelid is covering part of the iris in both eyes, and you want to know if that is going to change; you ask if the doctor took off too much skin;  and state at the end of the question you were hoping to get the result like using the tape you used to create the crease prior to surgery.
I can give you some understanding of where you’re at in healing, without complete information about what type of surgery you had, and the exact details of surgery. I can give you some guidance as to how I explain what healing is like for Asian eyelid surgery. 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. Asian eyelid surgery is a significant part of my practice. I’ve spent a lot of years educating people about the art of Asian eyelid surgery, and can give you a little sense of how I make a determination just looking at what your concerns are, starting with the goal of what your eyelids look like with tape.
In the decision making process for Asian eyelid surgery, the first question I have when I look at somebody who wants a double eyelid, or double fold type of crease formed, is if there is a need to remove skin, or remove fat, or both. Basically there are diverging 2 choices: a non-incisional surgery, or an incisional surgery. Based on the question about the tape, I suspect your doctor made the decision to do an incisional operation for reasons that include the likely presence of extra skin. There may have been an opinion that incisional surgery may work a little more for you compared to a non-incisional procedure. Both techniques are valid techniques, it’s just a matter of what is likely more successful for you. Apparently your surgery was the incisional surgery, so now the question is about the healing process.
Whether it’s non-incisional or incisional surgery, the key element of Asian eyelid surgery is to form a crease to connect the skin to a muscle called the levator muscle, which you alluded to in your question, which is the muscle that lifts the eyelid. Now, whether it is non-incisional or incisional, there is a tendency to create a fair amount of swelling between the crease and the eyelid margin which results in making the crease look high - that basically addresses your second question where you’re concerned about the height of the crease. I try to explain to all my patients to anticipate that the crease will look too high early. Sometimes people like that, but usually people want a more natural looking crease, but it is likely the swelling will resolve and the crease will get lower.
As far as the steroid injections, I’m confident you chose your surgeon based on your surgeon’s experience in Asian eyelid surgery, so I defer to your surgeon’s decisions as to what justified the steroid injection. It is not unusual to have some degree of inflammation as part of the normal healing process. One of the things I do caution my patients about doing, especially during the first month after any eyelid surgery, whether it is Asian or non-Asian eyelid surgery, is the incision can look a little red, a little bit bumpy, and can look thick. Very often, people believe this is the undesirable result of scarring, commonly referred to as keloid, but I explain to my patients that in the beginning of the first month, we look at wound healing - this is a time of a lot of collagen placement, inflammation, and processes that can create the incision to make it look a little bumpy and maybe a little red.
Even with that knowledge, a lot of people take the advice of well-meaning friends and family, so they’ll put things like vitamin E or cocoa butter a little too early, then end up causing more inflammation. A lot of these over-the-counter scar prevention creams have preservatives and oils that can be irritating. Whether or not you did that, if your surgeon felt the incision may have look a little more red than they were comfortable with, steroid injection is obviously of value- let your surgeon guide you. I think it is very difficult for any doctor to make an assessment based on a simple snapshot. If you are doing your followups with your doctor, your doctor will be the best judge of how things are going.
In terms of the eyelid covering part of the iris, that can be a combination of factors. One is the physical weight of swelling along the margin between the eyelid margin and the crease. The swelling can cause something called mechanical ptosis - a little extra weight on the eyelid pushes the eyelid down. Two, the fixation onto the levator can have some degree of tethering which can affect the eyelid height, but generally this temporary and resolves with swelling resolution.
As far as the question if the doctor take too much skin, generally speaking with Asian eyelid surgery, I think most doctors who perform the surgery tend to be conservative in taking out skin. I think anyone who does Asian eyelid surgery with any significant frequency understands that it is not usual, unless someone who is considerably older, taking out a lot of skin, usually anywhere from 2-4 mm of skin in terms of width, and you’re taking off enough skin so you have just the right amount of overlap of the fold to look natural. The odds are in your favor your doctor didn’t take too much skin, and again this is an ongoing discussion between you and your doctor.
I think the take home message is continue following up with your doctor, and have some confidence in the follow up process and the management. Surgery is a single event, but management afterwards, especially if there is any degree of inflammation or swelling that is slightly outside of the norm, but I think in general most of your healing process is as expected, and it’s only the incisional redness that may be an area of concern that your doctor is clearly monitoring appropriately.  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.

The appearance and height of your creases will continue to change as your eyelids heal and the swelling resolves over the course of this year.  Symmetry will likely improve as you heal, but follow up closely with your surgeon to ensure the best results.    

This is an unusual amount of scarring at the inner aspect of the incision.  All you can do at the moment is watch it closely.  Give it time.  Maybe repeat the Kenalog injection with 5-FU. Regarding the height it will most likely come down as the weeks and months goes by to stay calm.  Get second opinions if needed but I would not entertain any revisions at the moment.Chase Lay MDAsian eyelid surgery specialist