is a secondary procedure reasonable for upper bleph eyelid surgery scars?

I am 1 year post op from upper bleph surgery. My surgeon used laser with undisolvable sutures. I have devekoped wide white scars within the eyelid crease but they are very visable when I close my eyes or raise my eyebrows. When eyes ar open there is a slight visable scar on the very inner corner of the eyes. Even after a year the scars still seem to be evolving. My PS (a reputable Occular plastic surgeon) suggested the scars could be cut out with a scalpel, (I think he said he would remove the old sutures- not sure) and re-sutured with a different type type of suture (disolvable) . He said there would be more swelling and bruising than the laser surgery but I would be left with thinner scars. Does this sound reasonable or should I get a 2nd opinion? I trust my PS but am a little nervous about having to go through the healing process again. any input would be  greatly appreciated.

Doctor Answers 10

Contrary to popular opinion, laser is not an ideal cutting instrument.

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Laser creates a lot of thermal damage in its wake that must be healed by the body.  There are very few circumstances in my opinion where a laser makes a better instrument for cutting skin than cold steel.  Cold steel does not burn the tissues.  Sutures can be rapidly removed helping to minimize the appearance of the wound as it heals.  In contrast, the laser weakens the skin edges, sutures must be left in much longer.  This is less than ideal.  Scar revision is the correct answer.  This may or may not improve the appearance of the scar in the long run.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

S a secondary procedure reasonable for upper bleph eyelid surgery scars?

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Hello! Thank you for the question!  Revision is reasonable given your description.  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. Using ointment or Vaseline does well - avoiding creams and lotions to eyelids. 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!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Scar revision for unsightly upper blepharoplasty scar

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Thank you for your question. It is reasonable to consider scar revision for upper blepharoplasty scars in the case of unsightly scars 1 year after surgery. Sharp excision of your current scar with careful reapproximation may be an option. If you are uncertain, consider seeking a second opinion as you suggest. Good luck.

James M. Pearson, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 135 reviews

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Eyelid scar revision

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Upper eyelid scar revision is possible. The scar is unlikely to improve much more after one year from the surgery.  If you feel uncomfortable with your surgeon, get a second opinion from an oculoplastic surgeon.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 88 reviews

You may consider getting a second opinion about your upper blepharoplasty scars.

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I read your concern:

Upper blepharoplasty scars heal as a fine white line in nearly everyone. A wide white line could be improved via scar revision, but my concern is that your scar is visible with your eyes open, in the inner corners near your nose. Scarring where the eyelid skin meets the nose may be difficult to correct, as unsightly webbing may occur in this area. In that regard, you should consider getting evaluated by another reputable, experienced blepharoplasty surgeon before proceeding.

I hope this is helpful for you.

Regards from NJ.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 432 reviews

Scar revision

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Dear Nashville,

       I agree with the other experts' opinions.  Namely, laser surgery can, in some people, cause more scarring then a blade.  Not only does the body have to heal from the mechanical injury of the wound, but also from the thermal injury of the laser.  How do you heal generally, do you have scars elsewhere?  Those are other things to take into consideration.  Scar revision is certainly a reasonable option, and with a blade, assuming you have enough skin to remove without causing further problems (a discussion to have with your surgeon).   You'll have to do it to be able to ascertain if it is an improvement.  If you are truly unhappy, then it may be worth that risk to you..otherwise it may be something you'll need to cover up. 

Good luck!

Jasmine Mohadjer, MD

Oculoplastic Surgeon

Tampa Bay, FL

Jasmine Mohadjer, MD
Tampa Oculoplastic Surgeon
5.0 out of 5 stars 2 reviews

Revision might improve the scar appearance.

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As you know, any incision we make, whether with a knife or with a laser will heal with a scar. It appears that your scar formation may have been more noticeable than is acceptable to you. Is it possible that the scarring was "thicker" than most due to the laser. Yes, that is a possibility. But the fact remains that everyone heals differently and its quite possible that the response was  your body's unique healing response.

I believe that the recommendation by your surgeon is definitely reasonable, and certainly may improve the scar appearance. Hhowever it is not a guarentee that your future scar will be any less noticeable than the current one, as your body's response may be the same.

Good luck

seattleface com

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 41 reviews

Blepheroplasty scars

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If you have enough tissue on your upper lids, a scar revision would be apropriate at this time. I would agree that switching to cold steel is a good idea

David A. Bray, Sr., MD
Los Angeles Facial Plastic Surgeon

It is reasonable to revise prominent or unsightly scars

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Generally if a scar is wide or thick, there may have been too much tension across the closure either by removing too much skin or not closing the incision strongly enough to resist the forced acrossed the closure. Given your description of your upper lid scarring, it is reasonable to surgically revise them by excision or cutting out of the scar. The only concern is if you have enough skin for a relaxed closure to be accomplished; otherwise, the problem is likely to recurr. Sometimes, you can improve the post-op skin closure when the skin is tight, by pre-treating the forehead and glabella with Botox or Dysport 7-10 days before the upper eyelid procedure. This way, there is very little tension across the closure and in 3-4 weeks, the incision is completely healed and will not widen when full muscle activity returns. If the excision does not appeal to you and if the scar is thickened, raised or hyperpigmented (dark), you may consider a fractional CO2 resurfacing with corneal shields. Its a conservative treatment which may need to be repeated in 6 months, but the scar may be much less noticible without the risk of further lid shortening as with a scar excision.

Edwin Ishoo, MD
Cambridge Facial Plastic Surgeon

Scar Revision After Blepharoplasty

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Generally speaking, upper eyelid surgery heals very nicely with thin, hardly perceptible scars.  However, the healing process can vary based on the patient and the situation. I think that your Surgeon is offering a reasonable solution assuming enough skin remains on your upper lids for safe removal.  The real question is whether or not you are comfortable with your Surgeon and his ability to correct the problem.  The fact remains that if you are unhappy with the scars, they will have to be revised surgically.  As an aside: there shouldn't be more bruising and swelling with a scalpel compared to a laser.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 103 reviews

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.