Risk of Upper Eyelid Blepharoplasty for Keloid Prone Skin?

Hi, I have "keloid prone skin" and I was wondering what would happen if I get the incisonal upper eyelid blepharoplasty??? I have one uneven monolid eye and one big (in comparison) double lidded eye. I would just like to even out my eyes

Doctor Answers 18

Little to no risk of keloid in eyelid skin

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In almost 18 years of performing eyelid surgery, I have never encountered keloids around the eyes. You are a safe bet to proceed. Best of luck. Dr. G

Orlando Facial Plastic Surgeon
4.8 out of 5 stars 35 reviews

Upper lid blepharoplasty - risk for keloid prone skin?

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Excellent Question. In general, the risk that upper eyelid surgical scars will form keloids is extremely low, even in those with a history of keloid formation in other areas. Be sure to discuss your history and concerns with your surgeon. Good luck.

James M. Pearson, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 137 reviews

There are special precautions that you can take with people who are prone to keloids

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It is relatively unusual to get keloids around the eye skin.  That being said, there are special precautions that you can take with people who are prone to keloids such as the type of suture used and following the scar formation closely. 

Joseph A. Eviatar, MD, FACS
New York Oculoplastic Surgeon
4.7 out of 5 stars 68 reviews

Scarring after eyelid surgery

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Upper eyelid blepharoplasty incisions tend to heal very well, even in patients who are prone to keloidal scarring.  It may take many months after surgery for the scars to become as smooth and flat as we would like.  Occasionally small cysts form along the incision line where the sutures were placed.  These cysts often resolve without treatment but occasionally need to be opened by your doctor. 

Brian Biesman, MD
Nashville Oculoplastic Surgeon
4.8 out of 5 stars 43 reviews

Upper eyelid (blepharoplasty) keloid risk

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This is historically a very rare area to develop keloids, even in patients with a prior history of keloids elsewhere on the body.

Christopher R. Hove, MD
Paoli Facial Plastic Surgeon
5.0 out of 5 stars 5 reviews

Keloid after blepharoplasty

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I would agree with the other surgeons that a keloid of the upper eyelid is not going to happen.  However, you will have to consider the possibility of a hypertrophic scar, which is sometimes confused.  Hypertrophic scars don't overtake the margin of the original incision like keloids do.  So your scar could thicken, become raised, slightly wider. 

That too is still very uncommon in eye surgery.  But if too much skin is removed, and the closure line is therefore under undue tension, you might get some hypertrophism.  That is usually managed by injections of a steroid, so there is a solution.

So you need to be clear with your surgeon in conversation.  If you are worried about keloids, don't be.  If you are worried about a thickened hypertrophic scar, it is still very unlikely and a more conservative degree of surgery might be prudent.

Kevin Robertson, MD
Madison Facial Plastic Surgeon
4.7 out of 5 stars 15 reviews

Upper eyelid surgery and keloid risk

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IMHO, the risk of a keloid from an upper eyelid surgery is astronomical...have consults with plastic and cosmetic surgeons or occuloplastic surgeons for further advice.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Low chance of keloids

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The chance of forming a keloid on the eyelid is extremely low.  When done properly, a blepharoplasty leaves very little tension on the scar, which can be a contributing factor for keloid and hypertrophic scar formation.  I have never seen a keloid on the eyelids.

Mikel Lo, MD
Tucson Oculoplastic Surgeon

Uneven upper eyelids

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I'm not certain what exactly is meant by "keloid prone skin" as many individuals mistake exuberant scar or hypertrophic scar with "kelods" which are a specific pathologic scarring seen most commonly in African-Americans and Asians. Hypertrophic scarring is definitely related to increased tension at the wound closure but "Kelois" can forn on any incision with or without tension such as a simple ear lobe piercing. Generally the reason why Keloid of the upper eyelid is extremely rare is because virtually all surgeons will avoid performing a cosmetic surgical procedure on a patient who has demonstrated that they are true kelod formers, and since most upper blephs are done on older patients, we have a long medical history to rely on. I don't know any histologic basis for the upper eyelid skin to be immune from this pathologic reaction in a true keloid former. You need to have a specific evaluation by your dermatologist or plastic surgeon regarding your risk of true keloid formation before proceeding. Regardless of how rare this occurrence is, if it occurs on the upper eyelid, it will be a very difficult problem to correct and a cosmetic issue can potentially turn into a functional problem. I would suggest proceeding with caution.

The bigger problem is the asymmetric upper lids which can be a difficult problem to diagnose and treat. It may be masking an asymmetric facial nerve weakness or a levator muscle disinsertion and may not be just a routine bleph. Have a detailed ophthalmologic eval prior to surgery.

Edwin Ishoo, MD
Cambridge Facial Plastic Surgeon

Keloids after upper eyelid blepharoplasty

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As previously stated, keloids tend to form in areas where there is high wound tension, such as the torso and back. When a wound is closed, it is important to remove as much tension as possible from the skin edges to avoid keloids.

As an oculoplastic specialist who performs many blepharoplasties, I have never seen keloids form on the upper eyelids. The key is to take all tension off of the skin edges when you close the wound. This is done with stitches underneath the skin and then one to gently close the edges.

I am always happy to answer any other questions.

Briggs Cook

Briggs E. Cook, Jr., MD
Charlotte Oculoplastic 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.