Uneven inner corners from epicanthoplasty? (Photo)

Question

I got Asian double eyelid and epicanthoplasty performed 6 weeks ago. Not only do I notice that my eyelids are uneven (my right eye's crease is too small and I'm afraid it might get smaller as time goes on). My inner corners from epi are different. The right eye's inner corner looks sharper. While the left eye's inner corner looks more rounded. Will I need an epi reversal as well as a revision for my eyelids in the future? I really do not want to go through surgery again. :(

Goretti Ho Taghva, MD, FACS · Answer

Thank your for sharing your photos.  Your double eyelid surgery has healed well, but I agree with you that the left inner corner looks rounder than the right.  This could be due to the surgical design/technique but also could be due to scarring.  Often times, the medial epicanthoplasty scars are thicker than the double eyelid scars and would require kenalog injection and massaging to soften them.  If the scar is not well managed, the scar can contract and the epicanthal fold may appear unchanged or worse, more pronounced than pre-op.  I recommend that you follow up closely with your surgeon. Good luck!

Shim Ching, MD · Answer

Thanks for your questions.At 6 weeks after surgery, it may be too early to determine the symmetry of your eyelid folds.  Most of my patients who have a non-incisional double eyelid procedure have minimal swelling at this point, but if you had an incisional procedure, you likely will still have swelling that could lead to asymmetry.  Best to wait for now.However, I'm not sure if your left eye medial epicanthoplasty was performed correctly.  It looks more rounded than it did before and at 6 weeks, the shape will not change that much.  You will likely need a revision in this area.Aloha,Shim Ching, MD

Amiya Prasad, MD · Answer

Thank you for your question. I understand you had Asian double eyelid surgery and an epicanthoplasty six weeks prior. You’ve submitted two sets of before and after photos and are concerned about the difference between your two eyes.I can give you some perspective on this issue as Asian eyelid surgery is a significant part of my practice, give you some insight on how I manage my patients, and the likely explanation from your doctor. I’m a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years.When it comes to surgery, especially surgeries that are as precise as Asian eyelid surgery, the phases of healing have a very important role in long-term results. There are technically four phases of wound healing: (1) the blood clotting phase, (2) the inflammatory phase, (3) the proliferative stage, which is also the stage you’re currently in, and (4) the wound remodelling phase.During the proliferative stage, the body is producing collagen so there’s a lot of activity, so things have a tendency to get tight, and the upper eyelid incision can look thick. This is a normal part of healing, and also a good time to use a topical cream such as Scarguard, or something similar. Separately, the epicanthal fold is a particularly sensitive area where the skin is prone to becoming quite thick and tight. This may be what is causing some of the overall asymmetry. Wound healing can last for up to a year or more, and during the last phase, the thickened scars eventually become softer and natural-looking.That said, now would not be the time to intervene with revision surgery. There may be some value in some topical massage to soften the area, which you can discuss with your doctor. If the skin is getting tighter on the epicanthal fold on the right side, then it can pull the skin down a little more tightly. Remember that swelling and wound healing are an important part of the process. If a revision is needed, you must wait at least until there is less swelling. Doing a revision in your current state, as  seen in your photos, would mean getting ahead of ourselves.Ultimately, it is not unusual for one eye to look different than the other at the beginning of the healing process. When healing begins at a more mature level, then the symmetry will probably be closer to what was intended during surgery. There is a golden rule- if doesn’t look good in the operating room, it’s not going to look good outside the operating room. In my practice, I operate under this principle — which is why, during procedures, we carefully measure and observe, and even have patients sit up and open their eyes, just to maximize predictability of results.I recommend you meet and discuss these issues with your doctor. I think it is still quite early to lose faith. After all, if you chose your doctor to do your surgery, it was probably because you believed your doctor would deliver the desired result. Your doctor has most likely spent a lot of time planning, drawing, and making sure that everything was measured and done appropriately. I suggest you meet with your doctor and see how you can go about your situation.I hope that was helpful and I wish you the best of luck!This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

R. Stephen Mulholland, MD (retired) · Answer

Dear vouloir,

Thank you for your clinical post and
photographs.  At 6 weeks the double fold
surgery in the epicanthoplasty looked like they healed very well.  It is extremely common that early
post-operative phase to have some significant asymmetries depending on the
relative healing capacity of each side of your upper lid, how you position your
head at night and whether you sleep on your front or side.

In general, many of the contours and
shapes you don’t like will change significantly over the next 6-12 months and I
would recommend doing no treatment at this time, but allow Mother Nature and
soft tissue healing to occur fully.  If
you have the same concern at 9 months I would return to your operative
physician to see if there is anything that can be done to provide an
enhancement.

One needs to be careful not to over
operate an upper or lower lid eyelid tissue, it’s very delicate and difficult
to reposition and I think you have an excellent result and just allowing Mother
Nature to soften this area will be of great assistance.

I hope this information is of some
assistance and best of luck.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto

Uneven inner corners from epicanthoplasty? (Photo)

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Answer: Uneven inner corners from epicanthoplasty

Answer: Uneven inner corners from epicanthoplasty

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Uneven inner corners from epicanthoplasty? (Photo)

Answers (4)

Answer: Uneven inner corners from epicanthoplasty

Answer: Uneven inner corners from epicanthoplasty

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Everything you need to know about Double Eyelid Surgery

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