Asian Eyelid Surgery Post Operative Healing after 6 months, 1 year, 2 years. Any suggestions?

Question

Typically how much does the eyelid fall after 6 months, 1 year, and >2 years of healing after asian blepharoplasty is done? Will it be the size of the crease that the incision was originally supposed to be made? For example, if the patient decided on a 7mm crease, will the final crease after all swelling is gone be ~7mm? Or will the crease be dramatically lower? Thanks.

Jan Zemplenyi, MD · Answer

Thanks for your question.Recovery from eyelid surgery takes several weeks and is different for
each patient.  Rather than talk about how
the eyelid progresses after specific periods of time, let’s talk about overall
trends in healing.   The position and
shape of the crease will evolve during healing. Immediately following surgery, the
crease will ALWAYS appear much too high and deep, and its true shape will
generally be obscured by distortion caused by sutures and swelling. Once the
swelling begins to subside, internal healing will still cause the crease shape
and height to stay high and change slightly day to day.  The height of the final crease (i.e., the
“fold” that is visible to others) is determined by the incision and the lowest
extent of eyelid skin overhanging that incision.  The “crease” can appear very high following
surgery because only the incision is visible. 
After final healing, the crease appears lower because the skin above the
incision softens and overlaps the surgical cut. 
Although crease appearance begins to reach an equilibrium at about two
months, some slight swelling persists for at least several months more, and so
the approximate final configuration may not be reached for 6 months or
longer.  In general, the amount of
swelling and the rate of healing varies directly with the aggressiveness of
surgery.  Tapered creases look more
natural faster than parallel creases, and lower creases look more natural
faster than medium height creases. Though rarely chosen, high parallel creases
take the longest to heal and yield the least natural appearing final result.

Chase Lay, MD · Answer

I perform the surgery everyday and what I can tell you is that you're on the right track. As time passes typically the visible crease does drop but the fold or the actual crease above the Tarsus typically stays roughly in the same location but does loosened with time. Once you get past six months or up to a year your eyes will probably look very similar at year two.  However, The invisible crease will become less noticeable or drop a bit as the years pass.  I have put side-by-side comparisons on my social media outlets of before surgery, three months, and even up to for five years and things tend to hold up very well.Chase Lay, MD

Amiya Prasad, MD · Answer

Thank you for the question. You ask about the healing process after Asian eyelid surgery, and you are focused on specific heights of the eyelid crease in millimeters, and the different points of time in the healing process. You want to know how low does the crease fall while healing, and if it is subtle or dramatic.

I can certainly give you some guidance on this question with the absence of a photo. I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Asian eyelid surgery is a practice focus and specialty of mine, and I deal with this type of question every day when we do consultations for Asian eyelid surgery.

For some understanding and perspective, I’ll first provide a bit of the basic anatomy relevant to an eyelid crease. In my practice and with my style, if someone wants an eyelid crease, my goal is to create a crease that looks as if nature created it. Approximately 50% of Asians have a natural crease or double fold, and 50% do not and have something called a monolid. When I evaluate a patient, I usually place an instrument to create a crease to see what would naturally occur if you were born with crease. I feel this is the aesthetic that people come to me prefer, and I feel it looks the most natural.

There are two basic approaches to creating an eyelid crease which depends on the presence or absence of extra skin or extra fat, so we make a decision between a non-incisional or an incisional approach.  A non-incisional surgery means I place small openings in the skin to create a connection between the skin and the muscle that lifts the eyelids called the levator muscle. If nature had created a crease, there would be natural connection there that creates a fold in the eyelid. If someone needs skin removal, then we do an incisional approach where skin is removed, and in some situations fat is also excised. There are hybrid versions of these procedures where there is a partial incision, or individual variations customized to create a natural-looking crease.

The healing processes in non-incisional or incisional surgery, especially in the first few weeks, makes the eyelid crease look higher than it actually is. This is due to the amount of swelling between the eyelid crease and the margin or the eyelashes that makes the eyelid crease look much higher than is intended. In general, I tell my patients swelling is still going to be present, even if you look pretty good for the first several months, and technically it can last up to a year. For most people, six months is when most swelling resolves and you can feel the appearance is stable.

To address the question about different heights of the crease during recovery and the final result, the way I typically figure this out is with the part of the eyelid called the tarsus. The tarsus is the kind of the backbone of the eyelid that determines where a natural crease would be. The height of the crease is relevant, but only up to the point where the skin is anchored to allow for a certain amount folding over of the skin to create a natural look. When we do this type of surgery on a non-Asian patient, it is very different story. We are often trying to excise skin or remove skin more aggressively to create a larger eyelid platform, basically the place where you put eyeshadow. However, with Asian eyelid surgery, it’s the amount of eyelid that shows that is customized, so the anchor point is typically higher or at the height of the tarsus, but the amount of skin allowed to fold over is what we aim for in skin removal, or the amount of skin that folds over in a non-incisional procedure. There is always a natural equilibrium occurring, and technically the crease can be somewhat mobile, so if you aim for a 7 millimeter crease as you asked, when you actually measure it after healing, with tension the skin can have a certain height, and without tension a different height. In the end, I think it is not helpful to focus on the height of the crease, but rather on what is your ultimate desired result. When you want a particular elevated position of the crease to be exactly where you place it, it is actually a more technical issue for the surgeon to try to ensure the final cosmetic outcome is desirable.

I recommend you meet with your doctors who have a lot of experience with Asian eyelid surgery and discuss this question and concern. Often people get very focused on these numbers, but the human body is much more elastic and there ways to balance the factors that ultimately result in a good cosmetic result. Learn about your options and see what type of procedure will be best for you, review some before and after pictures with your prospective surgeon, look at the different stages of healing, and you will get a much better sense than asking about the theoretical.I hope that was helpful, I wish you the best of luck and thank you for your question!

Asian Eyelid Surgery Post Operative Healing after 6 months, 1 year, 2 years. Any suggestions?

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Asian Eyelid Surgery Post Operative Healing after 6 months, 1 year, 2 years. Any suggestions?

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