Upper Blepharoplasty Scar Healing Problem?

You either gave a cyst or an unusually thick scar at that spot.  If you were my patient I would proceed with a scar revision.  No need to wait any longer.

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

Often a scar gets worse before it gets better. Although in your case it appears from the photograph that you have an inclusion cyst. Simple excision and closure will treat the problem and you'll be on your way to recovery. 

Hello! Thank you for the question!  Your photos could certainly be s reaction to sutures, a suture franklins, or even perhaps a cyst.  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.  Follow up with your surgeon for management and possible excision/scar revision if needed. Hope that this helps! Best wishes!

Although most scars settle in about 12-15 weeks on the upper eyelid there are times when they can be more prominent.  Genetics play a role.  However by the description given these appear to be small cysts that have formed- this is common on the eyelid.  If one turns red and increases in size it is possible that it is infected- time to visit your surgeon.  Although many will ultimately go away, some even if not infected may require removal.  Other possible causes include retained stitch material.  There are some suturing techniques that result in less cyst formation than others.

After three months, most upper eyelid incisions have minimal redness. The bump on your upper eyelid suggests the possibility of hypertrophic scarring or an inclusion cyst. An inclusion cyst can occur when the outer layer of skin is turned inside out and as a result, grows inward forming a cyst. It can also occur when retained suture remnants are left in place. Infection and resultant inflammation can create the redness and tenderness that you describe. Bumps like this can also be seen with hypertrophic scarring. Sometimes, chronic inflammation can create a raised tender scar,

Early in the post-operative period we generally recommend massage. However, at this point surgical excision might be considered. You should consult your plastic surgeon for his opinion regarding this eyelid lesion.

Swelling of the upper eyelid incision may likely represent a cyst, either from a trapped suture deep in the skin or trapped epithelium under the skin. More concerning causes for this swelling may be infection / abscess or early scarring. Most expected swelling and redness after blepharoplasty usually only lasts a short period time, and 15 weeks is unusually long.
Treatment is relatively minor which may include a minor revision procedure, stab incision and drainage of fluid, antibiotics, steroid injection, warm compress, and massage. Watchful waiting is another option, depending on complete evaluation.
Speak to your plastic surgeon again, and discuss these various options.

While the scar is more reddened than usual, it should resolve with time.
I have found it often responds nicely and heals quicker with treatment with a vascular laser, such as a 532 or 1064 laser that helps to lessen the redness and cause quicker scar resolution. A lot of physicians carry that type of laser in their practice.

I would agree with the comments of others made here. It is not uncommon to have an inclusion cyst along the suture line. Occasionally, these get inflammed and other times they get infected. Treatment typically consists of evacuating the cyst.
Alternatively, it could be an inflammed nodule that would benefit from steroid injection.
Seek the advice of your surgeon and proceed with his/her recommendations.

Hi Nancy,
The only thing that I would add to the excellent comments of the other physicians is speaking to your surgeon about the possibility of a very dilute and very small quantity of a steroid injection (0.02-0.05 cc of Kenalog-10) directly into the scar tissue.
I hope that your scar resolves quickly.
Dr. P