Thick Scar and Ridge After Blepharoplasty

The other surgeons all have great suggestions about being patient with the healing process, using silicone oil scar fading treatments, considering laser treatment, and down the line considering a scar revision if necessary.
There is another option to treat the red, thickened scar tissue (which at a microscopic level is very metabolically active fibroblast scar tissue). 5-flurouracil is a drug that can arrest the activity of scar tissue. It is technically a chemotherapy drug, but is now often used off-label for treating scar tissue. Kenalog or steroids are a much more common treatment for scar tissue due to their similar effect on scar tissue, but steroids carry risk of pigmentation changes and causing a depression.
You may need to ask around in your area for a surgeon that uses 5FU in this way, and you will probably need to sign a specific consent for this type of treatment. I've found it to be a effective minimally invasive non surgical treatment for scars such as yours.

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

The length of the surgical wound is appropriate for your upper eyelid blepharoplasty. It does loop upwards a bit, but will probably fade to the point of being insignificant with time. If the final scar is unpleasant to you, then revision is possible. Try to be patient in the meantime. 

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!

Your surgeon did the right thing extending the scar beyond the corner of the eye.  If that is not done, there will still be a hood at the outer corner.  I do think you need a revision to remove that food of skin you mention.  It is not unusual to need this done and it is quite a simple revision.  I'm sure your surgeon will be able to do this for you.

Unfortunately, scarring is a part of any surgical procedure. Whenever possible, plastic surgeons place scars where they are well hidden by anatomic structures. When upper lid blepharoplasty is performed, every effort is made to hide the incisions. On the upper eyelids the incisions are hidden in the eyelid crease where they are extremely difficult to see. Unfortunately, in cases where there is lateral hooding and large amounts of excess skin, the incision needs to be extended beyond the crease. This is necessary to avoid a phenomenon known as a dog ear, where there is an abnormal pleat in the skin.

It appears that this maneuver was necessary in your case, to avoid gathering the skin at the corner of the eye. The scar is very red and noticeable at this point in time. Over the course of time, this should improve significantly. Scars generally take about 12 to 18 months to reach maximum improvement. In six months, the redness should be significantly improved.

In the meantime, the scars can be hidden with makeup. Occasionally, massage and steroid injections may be helpful. If scarring fails to improve with these steps, a scar revision or a skin re-surfacing procedure may be necessary.

It’s important to maintain good communication with your plastic surgeon. It’s still very early in the post-operative period and significant improvement will probably occur. Be patient, you may ultimately be very happy with your result.

Scars very from one person to the next and should be given some time to settle down.
After several months recheck the scar and if it is still thickened then it can be revised or injected with steroids or treated with LASER.

Your scar will likely improve with time. However, you will likely require a scar revision to achieve the best results. I agree that massage and time will help. Your scar is not longer than usual. However, it i does take a fairly acute turn laterally. In the mean time, it may also help to have some Botox injected in the lateral orbicularis muscle to help relax the area and slight elevate the lateral brow. This may help the area heal smoother and lifting the brow will less the skin fold that is presently there. Good luck with your recovery.

Dear Aisling
This incision is there so that the surgeon could remove more of your upper eyelid hood. Unfortunately unlike the reset of the upper eyelid scar, which is hidden in the eyelid fold, This part is out there for the world to see.
The most important thing to understand is that with several more months of healing this issue will be significantly less conspicuous. I often see patients shortly have upper eyelid surgery where for one reason or another, their blepharoplasty sutures separate. This results in a big ugly looking gap in the skin. They see me because their surgeon is unsure if the gap should repaired immediately or sometimes they search me out for an independent opinion. As ugly as these are initially, it is absolutely amazing how well they heal on their own. Very few people with this problem feel they need the incision revised.
I think that it is important to avoid the temptation to have something done at this stage of things. A well meaning surgeon can sometimes be persuaded to inject a spot like this with steroids to help speed up its resolution. This is often a mistake because the steroid can cause atrophy of the adjacent fat. TIme is the best treatment here. If the line is still an issue in 6 months, then a revision of the scar is a relatively minor procedure.

Extending the upper blepharoplasty incision outwards towards the brow tail is common practice to improve "lateral hooding" of skin at the outside edge of the lids. It appears that the incision line has seperated a little bit in your case.
This will improve quite a bit with time but it may not be to your liking at the end. If after about 4 months or so the scar is still unsatisfactory, you may want to discuss a little revision procedure which should be easy to under local anesthesia in the office setting.