Should Blepharoplasty Scars Be Less Evident by Now?

Question

I had eyelid surgery 5 weeks ago and my scars are still prominent even with makeup. I have followed recovery instructions and use an oitment my doctor had me start 5 days after surgery to hasten healing.
My scars are not only a very visible and long redline, they also are thick and raised -- very promenent when I close my eyes and touch my scar. The doctor said this is no problem, such evident scaring is normal at 5 weeks. However, I have read in more than a few articles and websites that eyelide scars should be not much noticeable by this time.
Am I impatient? Or, if red, thick texture lines at 5 weeks is not usual, what should I do? This is my second eyelid surgery. Does that make a difference?

David Shafer, MD, FACS · Answer

This is a good question. 
Whenever you have a wound or incision, the healing scar must mature, which involves multiple phases of collagen transformation.  At six weeks, the collagen is the thickest and then over several weeks flattens.  At the same time, the overlying epidermis of the skin turns red or pink and then over several weeks returns to your normal skin color.  However, incisions may still be distinguishable depending on factors which you really can't control - genetics, infection, etc.  However, blepharoplasty incisions tend to heal very well.  The best way to help your incisions is to leave them alone and allow the healing process to occur.  Many ointments and lotions cause irritation, especially with continued use.  Another important factor for healing incisions is to protect them from the sun with SPF lotion or, as in the case with blepharoplasty, wearing sunglasses.  
I hope this was helpful.
David Shafer, MD
NYC

James R. Gordon, MD, FACS, FAAO · Answer

Be patient for the scars to improve. Visible marks where the incision sites were at 5 weeks is quite normal. It can take up to a year for the scar to form what its final appearance will look like. Usually it barely perceptible. Make sure to wear sunglasses so that the scar does not become pigmented.

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!

George Volpe, MD · Answer

Blepharoplasty scars can be prominent at five weeks. This can be very individual and your genetics play a role but it is not that unusual. I find that it takes about 3 1/2 months for scars to fully settle down for most. Do remember, although they may appear very prominent to you, others may not be able to notice your scars unless you point them out. If it is your second surgery as you indicated, pre-existing scar tissue may trap a bit of swelling longer than someone undergoing a primary blepharoplasty and it may take longer for your scars to settle.

Ronald J. Edelson, MD · Answer

All scars actually get a bit worse before they get better, and you are at the time when they are typically the reddish.  This will improve with time, but you should check with your surgeon to make sure things are healing properly.

Raffy Karamanoukian, MD, FACS · Answer

Blepharoplasty scars can be improved using laser, scar creams, and gentle massage. Most will resolve quite well after surgery. Raffy Karamanoukian Los Angeles

Richard J. Bruneteau, MD · Answer

Anytime an incision is made, scarring will occur to some degree. The eyelid is an area where scarring is usually minimal and the scars are well hidden in this location. It usually takes 12 to 18 months for scars to reach there maximum recovery.

	Local wound care can minimize the potential for adverse scarring following surgery. In the immediate post-operative period, removing sutures in a timely manner can minimize adverse scarring. Avoiding crusting and scabbing of the eyelids by keeping them lubricated with ointment can minimize indentations in the scar. Avoidance of infection can minimize hypertrophic scarring and spread of the scars.

	Massage and rarely steroid injections may be helpful when hypertrophic scarring occurs. Unfortunately, after 18 months, the option that would most likely be effective is scar revision. Under these circumstances, a small excision with re-closure could be performed under local anesthesia. This would hopefully correct your problems and give you the result you’ve been looking for. For superficial scarring, dermabrasion or laser resurfacing may adequately correct the problem.

Jeffrey J. Roth, MD, FACS · Answer

You are still early in your post operative course. Scars need to go through a phase of maturation. This can't be rushed. Usually blepharoplasty scars heal well. Keep them out of the sun if you can. Please call your surgeon and let him/her know your concerns.

Mark Berkowitz, MD · Answer

I am sorry to learn about  your concerns.  After 5 weeks I would still expect your being able notice  the eyelid crease incision ( I assume your are speaking about an upper eyelid surgery.)  Everyone is different in the amount of time that this takes to heal.  If the area is raised you can very  gently massage the area 2-3 x/ day for 5 minutes.  Please also speak to your cosmetic surgeon about creams that can be massaged  into the area to improve the line faster. 
As an Ocular Plastic Surgeon I am routinely asked to improve incision lines and contours of the eyelid after blepharoplasty.  Some patients need to have the scar line removed and resutured; others can benefit from laser skin resurfacing; but more often than not watchful waiting is all that is necessary.
Lower eyelid surgery is accomplished at my office without any skin incision at all.  I gently remove the fullness (fatty tissue ) from the inside of the eyelid. I then tighten the skin with CO2 (carbon dioxide) laser resurfacing. NO stitches, NO skin Incision and NO scalpel.
Being your second eyelid surgery should not make a difference in the healing of the skin unless you had a lot of scar tissue from the prior procedure.

Michael Law, MD · Answer

Blepharoplasty scars should not be noticeable. If you look at my gallery, you can get close uo views of eyes and incision sites  Without photos I can't make exact suggestions, but there are options to improve your situation. Cosmetic lower eyelid surgery has undergone a paradigm shift over the twenty years since I began my plasticsurgery training, as has facial rejuvenation surgery as a whole. The trend has been to move away from highly invasive procedures that focus on skin and fat excision and pulling skin structures as tight as possible (which tends to make a patient look less youthful and more like a stereotypical ‘plastic surgery patient’), and towards procedures that accomplish not only soft tissue preservation but also soft tissue enhancement – in the form of structural fat grafting. A typical 1970-1980’s era lower blepharoplasty usually consisted of the surgical removal of large volumes of lower lid fat, pulling the lower lid skin very tight and anchoring the lid laterally in a manner that often distorts the natural anatomy of the lateral canthus (lateral corner of the eye). I suppose you could say that this matches a windswept, pulled tight facelift - but it is not in any way truly rejuvenating.Current, state-of-the-art lower blepharoplasty focuses on soft tissue preservation, including some or most of what appears to be ‘herniated fat’. A number of techniques have been described that restore ‘herniated lower lid fat’ to a more ideal anatomic position, although ideally such a procedure leaves the orbital septum intact as shortening of the septum by suture tightening or cauterization carries with it some risk of lower lid retraction. The trend has been towards limiting fat reduction to primarily older patients with very prominent lower fat pads. In many cases, the appearance of lower lid fat pad fullness can be effectively corrected by a combination of structural fat grafting of adjacent hollow areas like the tear troughs, elevation of the midface and smoothing of the lid – cheek junction by means of a High-SMAS facelift (if indicated), and tightening the orbicularis oculi muscles to the lateral orbital rim – which effectively restrains the fat pads and improves lower lid contour. Lateral orbicularis oculi muscle suspension is a very powerful means for reversing lower lid aging changes, and for doing so in a manner that does not distort natural lower lid external appearance.Preserving lower lid fat as much as possible, and restoring fullness in adjacent hollow areas by means of fat grafting, is a truly rejuvenating approach to lower lid surgery. Preserving and adding fat serves to enhance the soft tissue support of the lower lid and helps to maintain an ideal and youthful lower lid position over time. The more support you provide for the lower lid, the less you have to rely on internal support measures such as canthopexy and canthoplasty, which are useful for very lax and for overly long lower lids, but which also may distort the natural anatomy of the lower lid and upper lid.

Should Blepharoplasty Scars Be Less Evident by Now?

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