Upper Eyelid Scarring - Possible Revision / Treatment?

It's not unusual for patients to have noticeable scarring in the immediate post-operative period following any type of eyelid surgery. It's important to realize that all incisions heal with some scarring, but the eyelid skin has unique qualities that tend to minimize scarring.In the immediate post-operative period eyelid incisions tend to be red and raised. These scars tend to respond nicely to massage and avoidance of sun exposure. In the vast majority of cases, eyelid scars heal nicely with the passage of time. In many cases, these scars are imperceptible.Rarely, hypertrophic scarring does occur following this type of procedure. Under these circumstances, gentle massage and rarely, steroid injections are helpful. It's unusual for patients to require scar revision following eyelid surgery.It's important to maintain close contact with your plastic surgeon when hypertrophic scarring occurs. Your surgeon should be able to formulate a treatment plan that addresses your concerns.

Revision eyelid surgery should be done at least 6 months
after the initial surgery to allow time for healing and tissues to soften. Asymmetries, excess skin, fat rolls, fat malposition can all be improved. Other treatments may include laser or
chemical peels to tighten skin and improve texture

Hi Alpine,

You can speak with your treating physician about the possibility of intra-lesional injections of the steroid Kenalog-10 to soften your scar.  Good luck and be well.

Dr. P

Your scar is still very immature and it will take time for it to settle down. There are lots of ways to help scars mature, but ultimately time is your ally. Typically I recommend waiting 3-6 months before any revision surgery, except for unusual circumstances.

When the skin is injured it recovers in a series of phases. Initially there is an inflammatory phase which involves immediate local cellular responses (first few days). This is followed by the proliferative phase which involves continued tissue healing, collagen synthesis, wound contracture, etc. Finally, at around three weeks, the wound enters the maturation and remodeling phase. This is where collagen formation and other reparative responses subside. Please note that any of these phases can be prolonged in events of infection, smoking, diabetes or other wound impairing processes. At this time your wound appears to be in the proliferative phase of healing where it is not uncommon to feel some level of scar production. Your wound will most likely become more violacious over the next 1-2 weeks and aesthetically appear at its worst. After this point the remodeling phase will become the dominant phase and the site will then begin to improve in appearance. You may need to follow with your doctor for dermabrasion or scar revision, but as you keenly stated more time will need to pass before additional interventions are undertaken.Be healthy and be well, James M. Ridgway, MD, FACS

Thank you for voicing out your concern as well as providing a photo to go with it. Visible scars are common for people who have undergone eyelid surgeries. It is highly important for you to understand that incisions of any kind heal with a bit of scarring, although the eyelids are more special since scarring is minimized with the lids due to them having the thinnest skin in the entire body. Immediately after surgery, the incision scars on the eyelids will be observed to be raised or a bit swollen as well as reddish in color. With your plastic surgeon’s advice, you can gently massage these as well as avoid exposure to the sun. In most cases, as well as in my practice, lid scars can heal rather nicely through time that they even become indiscernible. If the scars are visible and do not seem to go away, gentle massages can help. You can also inquire about steroid injections. It is not really usual for patients to undergo scar revision treatment after a lid surgery. Always consult with your board certified physician regarding your concerns. He or she can help in evaluating your case as well as provide you with a suitable management plan to help you ease your concerns.

Yes, you are quite perceptive. It will take many months for the swelling and scar tissue to resolve a bit.  The scar may be able to be revised at that point.

Your scar looks new and everyone who deals with these injuries will tell you the same thing.....wait!  Continue with your routine and possibly have your doctor inject a small amount of Kenalog, a cortisone type drug that often helps thick scars soften and shrink after being injected directly into the scar itself. A revision may be what you need but it should be done after the healing is settled. Ultimately I would expect you to get a good result either through natural healing or with the help of Kenalog or possibly later surgery revision (which is an easy procedure for any plastic surgeon).

When the scar is not red (about 5-8 months) is  the time to decide on whether a revision is needed. 

These scars will take several months before they settle down and look better, but they will definitely  improve.  I would suggest massaging the scars several times each day.  You may want to apply a product like scarfade on the scar.  You could also choose to massage the scars with lanolin, Mederma or cocoa butter if you want  an alternative product to consider.  Scar revisions should not be considered until 6 to 12 months have passed.  The only reason to revise scars sooner than that would be if there was a functional loss or distortion to surrounding structures which is not seen in this picture.  Follow up with your local Plastic Surgeon for further opinions.

 

Good luck.

While I know that waiting can be emotionally frustrating, the healing process can be a slow and often temperamental one. Unfortunately, being patient is really necessary prior to considering medical intervention. If you are really concerned, having a follow up with your surgeon might help ameliorate and hopefully alleviate some of your fears.