What would you recommend for Blepharoplasty scar removal? (photos)

Question

I have terrible scarring after a bad blepharoplasty and now I'm looking for a specialist in eyelid surgery, someone who is best suited to remove my scars. What should I be looking for and where? I read that the choice of suture material and closure technique is important. Anything more? I really want this to be my last eyelid surgery and would travel anywhere in the world to meet the right surgeon. Also what can I expect from the surgery? Is there any chance at all to make the scars invisible?

John J. Martin, Jr., MD · Answer

This is not going to be an easy fix.  The scar is located several millimeters above the lid crease.  It looks like the wound opened during healing.  This happens sometimes, but usually the skin here heals much better than in your case.  There is not much space between the brow and your scar, so this will make it almost impossible to try and move the scar into the crease. You may benefit from excision of the scar to at least make it a thin line.  The scar still won't be in the crease, but I don't think it ever will be no matter where you travel to have this done.  If you do have some residual scarring, laser resurfacing should at least help to hide the scar. Laser resurfacing for this scar would not help very much. There are many excellent surgeons in Europe, so I would search there for an oculoplastic surgeon who does cosmetic work.

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

Pierre Guibor, MD · Answer

It will depend on the scar tissue below the deformity. My suggestion would be to see better two eyed photos looking straight, up and down. If there is any retraction of the upper lid, then you will need to release the traction bands and scar tissue. If you have no retraction of the upper lid, then I would suggest a very thin retroauricular skin graft. The graft must be under tension with tie down bolster and  shaved down with all of the subcutaneous tissue removed. See your local Oculoplastic Surgeon for best analysis and repair.

Travis L. Shaw, MD · Answer

Dear ZilvFirst off, Im terribly sorry about your experience. Im sure this is not the outcome you had hoped when thinking about the benefits from blepharoplasty.You are quite correct that technique in closure of these incisions is very important. The skin of the eyelids is the thinnest in our body and is about half a millimeter thick. Looking at your photo it looks like several things are going on: First, the incision appears to have pulled apart along its entire length, worse at the lateral aspect. This has led to a depression known as atrophic scarring. Second, it appears that the incision was not placed in the correct position of the eyelid crease, where it will naturally camouflage. Your incision was placed to high. Once again, so sorry.I work with hundreds of scar patients, and always let them know that they will always have a scar, and there is no way to make it invisible. Having said that, there are many things that can be done to improve scars and make them less noticeable. For your blepharoplasty scar, I see a couple of options:1. Surgical revision with meticulous suturing technique could be done to make the widened scar much thinner and more like a thin line. I would recommend laser resurfacing right after suture removal to improve the residual scar. Many surgeons would disagree and say to wait for a scar to mature before laser, but in my experience, lasering scars early gives fantastic results. This is backed up in the latest medical literature.2. Laser scar revision with transdermal drug delivery. This is a new technique and involves using laser energy for 2 benefits- inducing collagen remodeling, and helping to get drugs that encourage collagen growth deep into scars. I have had success using the laser to help fill in atrophic scars such as yours. The drawback in your situation is that more than one treatment may be needed for the best results. I agree with others here who have advised you to seek a board certified facial plastic, oculoplastic or general plastic surgeon. Make certain that you choose someone with experience in scar revision techniques. All the bestDr S

William LoVerme, MD · Answer

Any surgical procedure creates a scar that is permanent. What a good plastic surgeon can often do is hide the scar in an area that not so noticeable. Of course, the type of suture material as well as the technique of repair is also important. In your case there is a scar that is wide at the edge. This can be improved. It is difficult to tell if the scar is placed properly in the crease of the eyelid from your photo. Ideally it should sit at the peak of the crease when you open your eye and therefore is minimally noticeable. Scars that are too high can not always be brought down into proper position. A consultation with a well qualified surgeon is your most important next step. Surgeons from Plastic Surgery, Oculoplastic surgery (eye doctors) and Facial Plastic Surgery (ear, nose and throat doctors) are the only ones really qualified to perform this surgery. Be sure to ask for their credentials and how much of this type of surgery they perform.

Suzanne Kim Doud Galli, MD, PhD, FACS · Answer

Anytime you cut the skin, there will be a permanent scar. A scar cannot be removed but it can be improved. You have a widened, malpositioned scar. Your best option is to have your scars evaluated in person by a board certified facial plastic surgeon.

What would you recommend for Blepharoplasty scar removal? (photos)

Answers (6)

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