Thick Scar and Ridge After Blepharoplasty

I am desperate to know what to do. Seven weeks ago, I had a bilateral upper blepharoplasty. The plastic surgeon cut not only my eyelids but right out onto my face by more than a centimetre, above the corner of my eye, extending diagonally towards my brow. This has left me with two ugly thick scar lines which make me look like a clown. The edges of the cut are not joined tightly, particularly on the right side of my face, and I have a thick open ridge which is so ugly. I feel like a freak. I don't know what to ask for or what can be done to improve this.

Doctor Answers 19

Time will heal, but 5FU may help

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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.

Austin Oculoplastic Surgeon

Scars Generally Take 12-18 Months to Reach Maximum Improvement After Blepharoplasty; In 6 Months the Redness Should be Improved

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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.

Time will help this issue.

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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.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Too soon to judge the scar

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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. 

Thick scar and ridge after blepharoplasty?

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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!

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

Are scars present after upper blepharoplasty?

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With upper blepharoplasty, artistry is required with the surgical technique to hide the scars in the natural creases of the upper eyelid. If there is marked laxity in the skin towards the outside of the eye, the natural lines (termed crows feet) can be aesthetically used to hide the incision. Often there are eyelid asymmetries and changes in the position of a person’s skin crease that occur with facial ageing that need to be taken into consideration to give a final natural looking result. The final result of a scar is 12-18months after surgery and with careful planning and consideration should result in a fine line that is hidden in a person’s natural skin crease. Dr. De Silva has revised scars of patients who have undergone surgery elsewhere to improve symmetry and hide the skin incisions in a natural eyelid crease. 

Thick Scar and Ridge After Blepharoplasty

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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.

Paul Vitenas, Jr., MD
Houston Plastic Surgeon
4.8 out of 5 stars 116 reviews

Cortisone shots may help

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As far as the incision on the upper eyelids, the incision on the upper lid blepharoplasty must extend laterally and outward past the eyebrow, to totally encompass the lateral sagging of skin in that area. The incision only goes out as far as the excess skin is present. If the incision stops short, there will be an excess pleat or dog ear laterally out in the crow’s-feet area. The incision is usually blended in the crow’s-feet and is nearly inconspicuous after it is well-healed. In the first two months after the surgery, there is a small area of redness that can be detected but can be easily covered up with makeup. Cortisone shots can also be helpful at this period of time if the incision is red, lumpy-bumpy, and ropey looking. For many examples, please see our eyelid surgery photo gallery link below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

IPL and lasers can improve scars, but surgical scar revision is sometimes needed

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Dear Aisling,

Your incisions seem to be following a normal crows feet line. Perhaps he extended the incision in order to remove excess skin in this area. In any event, the scar is still early in healing.

The redness can be improved with an intense pulsed laser (IPL) treatment program.

In addition, in a few months, fractional CO2 or erbium laser treatments may also help to refine the scar. If the scar remains thick despite these treatment options, the scar may need to be revised.

Speak with your physician about these possibilities.

Joseph M. Perlman, MD
Houston Plastic Surgeon
4.3 out of 5 stars 27 reviews

Scar maturation takes 6-12 months

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It does take 6-12 months for the red color to fade from an incisional scar. Still based on location I believe that your incision may be slightly visible and may require camouflage make up. Some surgeons will extend the blepharoplasty incision over the orbital rim to obtain maximum tightening of redundant skin while other experienced surgeons avoid doing this for most patients unless there is a significant amount of lateral canthal hooding.

S. Randolph Waldman, MD
Lexington Facial Plastic Surgeon
4.6 out of 5 stars 19 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.