What options do I have to address the scar webbing and length of scar following blepharoplasty? (Photos)

These types of webs and unsatisfactory scars are challenging to fix. This is a complex multi contour area. A z-plasty is a mechanism for relaxing a web. The precise direction of this is an issue for these lateral canthal webs. Also this skin is loose making successful management of the issue more challenging. I prefer first managing these areas with a series of 5-FU to help relax the area. This will help soften the scar in the area and generally reduce the amount of work that needs to be done surgically.

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Scarring and webbing after eyelid surgery / blepharoplasty can be tough to manage and typically require surgery. Several different surgical techniques have been described. I perform a modified version of one of them which I’ve found to work well but haven’t published yet. I usually perform scar injections after surgery, and sometimes before as well.

Wishing you the best in your journey to get better.

In your age, scars may take 1-1.5 years to mature and change color; there is still time for that to happen? Possibly laser treatment? Webbing will not improve without surgery by means of "Z plasty". In person consultation with your surgeon or second opinion consultation with another board certified plastic or oculoplastic surgeon is recommended. Good luck.

Thank you for your questions and photos. Based on the widening of the scar and the delicate nature of the tissue in that area it is probably best to directly revise the scar. This would entail numbing up the area and making a small incision to remove the old scar. The new incision would then be closed carefully to avoid this type of healing. I recommend you schedule a consultation with a board certified Plastic Surgeon who has experience with revision eyelid surgery. In our office we offer 3D imgaging to give our patients an accurate idea of what the final result will look like. Good luck!