Steroid Injections for Scar Tissue from Blepharoplasty?

Question

I am now almost 6 weeks out from upper and lower Blepharoplasty. Scar tissue has formed under my lower right eyelid and I have been doing the massages for 2 weeks. My Dr. has given me the option of injecting steroids to dissolve this unsightly bulge. Has anyone had this done and what were your results?

Trevor M. Born, MD · Answer

Dear M. Lannie, does the bulge move when you move your eyes- up, down, left or right.  is it on both sides or mostly on the right side? is it soft or hard?  Has there been any improvement?
Healing with the eyelids can take time and massage and steroids will help. the most change you will see is in the first 4 months but the earliest time for more intervention in most cases is much longer.
 
The 'scar tissue' can be there for several reasons- fluid collection, swelling in the tissues (muscle, fat, skin), hematoma, residual fat.
 
the steroids will soften the scar tissue nicely- have to be done in small amounts and very dilute so there is not any atrophy of the skin and underlying tissues.
With Warm Regards,
Trevor M Born MD

Raffy Karamanoukian, MD, FACS · Answer

Plastic surgery scars require attention after surgery so that they remain cosmetically-appealing and barely noticeable. In our office, we use a protocol for scars that minimizes their activity in the 6-8 weeks after surgery. If you have late plastic surgery scars, you may also require laser and RF therapy to help reduce the longterm effects of the scarring. Keloids, hypertrophic scars, widened scars, red scars, and hyperpigmented scars all require scar modulation with topical creams followed by lasers and RF therapy. Topical skincare should be directed to a specific need, whether for pigmentation or hypertrophy and our office can guide you through the process to obtain the correct Plato’s Scar cream or Melarase cream for hypertrophy and discoloration. In terms of lasers, we would employ the vbeam laser for redness, Venus Viva RF, PRP microneedling, chemical peels, and Morpheus 8, fractional erbium, or fractional co2. All of these have their individual benefits. Most of all, we recommend you visit a solid plastic surgeon who understands surgical scar revision, laser therapy, and RF therapy for scars. 
 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Lewis Albert Andres, MD · Answer

Hello! Thank you for the question!  It is common for scars to fully mature for up to a year. In the meantime, there are a few things that may help to ameliorate your incision/scar. The most proven (as well as cheapest) modality is simple scar massage. Applying pressure and massaging the well-healed scar has been shown to improve the appearance as it breaks up the scar tissue, hopefully producing the finest scar as possible. Other things that have been shown to add some benefit, albeit controversial, are silicone sheets, hydration, and topical steroids. In addition, avoidance of direct sunlight to the incision will significantly help the appearance as they tend to discolor with UV light during the healing process. If unsightly scars are still present after approximately a year's time, other things that your surgeon may consider are intralesional steroid injections, laser, or just surgical revision of the scar itself.Hope that this helps! Best wishes!

David Shafer, MD, FACS · Answer

Steroid typically are not necessary after blepharoplasty, but can be very useful in specific situations. If you have extensive scar tissue or retraction of the lid, then injection of the steroids may help soften up the tissue and resolve the problems faster. Good luck with your recovery.

William Portuese, MD · Answer

Cortisone shots are a very acceptable form of treatment for small areas of bulging on the eyelids. If there is residual fat present, the cortisone shots will not help with this. We inject steroids into small areas of the incisions independently to effect a change such as flattening of the scar.

Christopher L. Hess, MD · Answer

I often hear about bulging scars of the lower lid. I'm not sure why it occurs unless the patient is of color and we're talking about hypertrophy of the scar. With that said I thinks steroids can help but if you are darker skinned this can cause hypopigmentation. A small amount of kenalog, i.e. 1-2mg would be all that I would inject. Waiting is not a bad option either.

Francisco Canales, MD · Answer

I would probably wait another 6 weeks before deciding on the final result.  You can have swelling for 2 to 3 months after eyelid surgery and injecting steroids now may be premature.
Steroids work, but they can thin tissues and cause atrophy that is not reversible.  Give massage some more time and wait on the steroids until all healing has taken place.  Even then, I would only use the most minimal amount of steroid (if at all).  Discuss the options with your doctor. You may also want a second opinion in the meantime.  Best of luck.

Steroid Injections for Scar Tissue from Blepharoplasty?

Answers (7)

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