3 mo PO upper/lower blepharoplasty, fat transfer, short scar facelift by a BCPS. Cause of ridge line under eye? (photo)

Hello.  Thank you for your question.  The ridge that you see on your right lower eyelid is your scar from the lower blepharoplasty incision.  You are still fairly early in the healing process.  When an incision is closed, it is typical to evert the skin edges so that the scar is slightly raised above the surface of the skin.  This is done so that as the scar contracts and matures during healing, it will result in a flat scar, rather than a depressed scar.  It is also common to get little bumps along blepharoplasty incisions.  These will likely resolve over time as the scar heals and matures.  It typically takes a scar  9 - 12 months to fully mature.  I would suggest patience with the healing process at this time, and it will likely require no additional treatment.  However, if the scar does not flatten and smooth over time, laser resurfacing or scar revision may be indicated.  I would recommend waiting until at least 9 - 12 months after surgery to consider any intervention, unless the scar is worsening with time, in which case earlier intervention may be indicated.  I wish you the best in your recovery process.

Dear Runner 0917,
Thank you for your question. It is difficult to make an assessment and recommendations based on photographs alone. I recommend you continue to follow closely with your surgeon with serial repeat evaluations if your eyelid issues do not resolve with time. The ridge you are experiencing can be due to a variety of issues, including raised blepharoplasty scar or milia. If this issue does not improve with time, follow-up with your surgeon to see if there are additional treatment options to remedy the issue, including possible scar creams or scar revision. 

There are two different approaches to lower lid surgery: one makes an incision inside the lid with no scarring. The other is an incision under this lid, done often when excess skin needs to be removed. The lower lid incisions can be troublesome, as they produce a visible scar and can occasionally pull down on the lower lid.From the photos you sent, it looks like you are experiencing hypertrophic scarring with some pulling down of the lid. I would treat this with steroid injections and massage now rather than waiting another 3 months, as it may worsen. Return to discuss your options with your surgeon.

From the picture at one week, it looks like you were having a reaction to the suture.  This can create a longer healing time, and some additional swelling.  I would recommend using warm compresses and some massage over the area to try and flatten it out.  Some silicone cream may also help.  If it doesn't go down in the next few weeks, some low dose steroid injection may help.   

 most patients are fully healed at three months after a upper and lower blepharoplasty procedure. From the photographs, it appears that the incision is still in the healing process with swelling and edema present. Consider a steroid shot if the scar itself is hypertrophic. Best to follow up with your operative surgeon.

Typically blepharoplasty incisions heal great and look good at three months. Everyone does not heal the same. If you have had a  similar scar healing process in other areas of your body, this may be normal for you. If you otherwise heal well, this may be a reaction to the suture material or even due to cautry used to control bleeding at the time of surgery. Massage is helpful but this is a hard area to massage. Ask your surgeon about low dose kenalog injections to speed the scar maturation. Revision is always a possibility. Good luck. 

Three months following upper and lower lid excisional blepharoplasty, the patient is concerned about residual bumps. Photographs presented but the sequence and timing is unknown. It is very common to have bumps in the eyelids following blepharoplasty which resolve after a varying period of time, up to six months or more. These bumps are attributable to thin eyelid skin with many glands and a tendency to retain swelling. Generally speaking elevation, massage, and perhaps in some instances even a small steroid injection might be helpful. Time is the best treatment as most of these will spontaneously resolve. Lasers can be used to improve scars if they continue to be noticeable after a few months. The advantage of a lower transconjunctival blepharoplasty is that there is no incision on the outside. Occasionally the bumps are caused by cysts which form in the suture line. These cysts can be opened and drained.

So depending on what type of stitch was used under your eye, it looks like you have had a reaction to it. This has left you with small granulomas which over time will settle. They are whats left after too much inflammation simply speaking. Certainly don't worry just yet. Things are clearly improving so hang on for a few more weeks. Hope that helps. Adam Goodwin

The bumps under the eye are related to the incision, incision closue with sutures, and the ultimate healing of the wound.  It is still early in the healing phase, although most wounds would have healed a little faster than yours, the wound can still reach a very acceptable end result.  Simple observation is needed, and patience is needed.  On a rare occasion, the wound remains visible and bumpy.  Various treatments (steroid injections) can provide further improvement.  Nonetheless, no treatment is recommended at present.

Your right eyelid scar, which is at the incision line, is still bumpy and prominent.  You are still in the early phase of healing at 3 months, so I concur with your surgeon in suggesting you wait for another 3 months to see how much the scar improves on its own.  If necessary, revision of the scar is straight forward and can very nicely improve the final result.