Asian, 25, male, 1.5 year blepharoplasty post-op, eye still very red, what's causing this? (Photo)

Hello,
Thank you for your question.
Persistent redness and sensitivity 18 months post-blepharoplasty is uncommon but not unheard of, particularly in individuals with reactive or sensitive skin. The most likely causes in your case are hypertrophic scarring, low-grade chronic inflammation, or even subclinical contact dermatitis exacerbated by mechanical irritation (e.g., rubbing). The scar’s vascularity (redness) and the fact that it flares with minor contact suggest that the tissue may not have fully remodeled and may still be in a prolonged inflammatory phase. While many scars mature and fade within 6–12 months, this process can be delayed in periorbital skin due to its thinness and high vascularity, and scarring patterns may vary based on ethnicity and individual healing response. A trial of topical anti-inflammatories (e.g. tacrolimus or low-potency steroid under supervision) or vascular-specific laser (like Pulsed Dye Laser or Vbeam) may now be reasonable, especially given the duration and your symptoms. Patch testing for allergic or irritant contact dermatitis (if any creams or tapes were used) could also be considered if inflammation continues.

Las personas asiáticas, al igual que otros grupos étnicos con piel más pigmentada (como latinos o africanos), tienen mayor riesgo de desarrollar cicatrices hipertróficas o queloides.
Estas cicatrices pueden permanecer visibles, enrojecidas y elevadas durante mucho tiempo, y se inflaman fácilmente con la fricción o el roce.
Aunque no todos los casos evolucionan a queloide, una cicatriz hipertrófica persistente

Ectopic location of incision, the scar is not where it should be at the very depth or aligned with the upper tarsal crease, the surgeon misplaced greatoy over eyebrow skin instead of eyelid one, and not only, the scar follows a straight pattern, should be sinusoid like low-high-low, contouring the natural skin creases.

You may be a candidate for a meticulous and careful set of z-plasties, located at both ends, and eventually check whether additional maneuvers are needed, given you are asian it is weird to be the creation of the tarsal fold was properly achieved with such scar location. It does not make sense to me that incision for a functional eyelid ptosis, I'd have gone insite the eyelid with a Fasanella-Servat procedure, so many questions here.

I agree that a year and a half is a long time to have persistent redness on a scar after upper blepharoplasty, or ptosis surgery. Sometimes people are sensitive to permanent suture material which can lead to chronic inflammation. This would be a good question to ask to your surgeon. Hope this helps. Sincerely, Dr Joseph

Hello!Thank you for your question.
As far as I can understand from your question After every surgery, a minimal scar will definitely remain, but I recommend that you discuss this issue with your surgeon and listen to your surgeon's recommendations.
Best Regards!

Have you tried the silicone gel sheeting for scar diminishing? How well you take care of your incision and a patient's genetic factor and the main factors. Knowing your skin and how well you fade in general will always determine the outcome of future scarring.

Prolonged redness/erythema along the incision line after surgery is fairly common for most Asian skin types. Limiting excess sun exposure is important to avoid pigmentary issues, and a tincture of time typically resolves most pigment issues. However in your case it is reasonable to me more effective with some laser treatments directed at the pigments involved. IPL (intense pulsed light) or PDL (pulsed dye laser) may be appropriate to reduce the redness.

People heal in different speed. However, 18 months is longer than we anticipate. Usually, eyelids settle completely around 3-6 months.
In your case, scar revision surgery can be performed using laser surgery, dermabrasion, cryotherapy, or skin grafting. During an evaluation with your surgeon, you can discuss the one most appropriate for you. Best of luck to you

Thank you for submitting your question! Dr. Persky gave his response in the attached video. Be well!

Thank you for sharing your question and posting your photo. Considering how prominent and red the incision site is either topical steroids, injected steroids, injected 5FU or excision of the scar can be considered. Sometimes a combination treatment is required. Make an appointment with an experienced oculoplastic surgeon for proper guidance.
Good luck,