Post upper blepharoplasty crepey eyelid skin and scar concerns - how can I treat this? (Photos)

Question

I had an upper blepharoplasty last July (it’s been almost a year now) and I’m concerned about how my scars look. It looks like he’s missed the actual crease of my left eye (pics attached) and my eyelid skin has become much more crepey, which they didn’t look like before. Is there a way to treat this? I feel more insecure than I was before.

Jeffrey M. Darrow, MD · Answer

Thank you for your photos. The asymmetry of your upper eyelids can be corrected by a revision of your blepharoplasty. When measuring the dimensions of the skin to be removed and retained, a caliper should be used to give the most precise result. When the incisions are properly placed and the skin remaining is the same on each eyelid, below and above the incision line, your result should be as symmetrical possible. A re-resection of some skin can also help to smooth the creepy skin. Best wishes.

Yasemin Aydinli, MD · Answer

Thank you for sharing this, and I'm sorry you're feeling more insecure &mdash; that's an understandable reaction, and at nearly one year there are real options. First, the reassuring part: at 10–11 months, upper blepharoplasty scars are usually still maturing and can continue to soften, fade, and flatten for up to 12–18 months, so some of what concerns you now may keep improving. Crepey-looking eyelid skin after surgery can result from residual skin, slight swelling that's still resolving, or simply how the skin is settling &mdash; and much of this responds well to non-surgical treatment.
For the crepey texture, options include fractional laser or a light resurfacing/peel around the eyelid skin, radiofrequency-based skin tightening, and a good topical regimen &mdash; these can improve skin quality without further surgery. For the scars and an asymmetric or "missed" crease, scar massage, silicone gel, and judicious treatments can help in the maturation phase; if the crease heights truly differ once everything has settled, a minor in-office crease-setting revision is straightforward and is usually best done after the 12-month mark when tissues are stable. The asymmetry you see in the left crease should be evaluated directly, because the right correction depends on whether it's a fixation issue versus residual skin or swelling.
My advice is not to rush into another surgery just yet &mdash; let the result fully mature and start with conservative measures. I'd recommend an in-person exam so I can assess the crease symmetry, skin quality, and scars closely, and lay out a stepwise plan from non-surgical skin treatments up to a small revision only if needed. You have good options here.

Kenneth D. Steinsapir, MD · Answer

You have PUBS (post upper blepharoplasty syndrome). This is a spectrum of concerns including a high or hollow upper eyelid, crepey eyelid platform skin, upper eyelid ptosis, eyelash ptosis, and a compensatory eyebrow elevation. It tends to make eyes look surgical and skeletonized. The good news is there is surgical rehabilitation possible to improve your concerns to improve your surgical outcome. There is no substitute for a detailed in person assessment.

Mehmet Ozdemir, MD · Answer

I can see why you're stressed about how your upper eyelids look a year after your surgery, but the good news is you don't need to go back under the knife to fix this. Looking at your photos in image, that crepey texture often happens when removing the heavy skin fold changes how the remaining eyelid skin drapes and moves. Because you are nearly a year out, your tissue is completely healed, and we can easily address these skin-quality issues without surgery. Your best bet to smooth out the texture and tighten that crepey skin is to use energy-based treatments like fractional CO2 laser resurfacing or radiofrequency (RF) microneedling, which build new collagen right where you need it. These lasers can also resurface and soften the scar line, helping it blend seamlessly into your natural eye crease. I highly recommend visiting a board-certified dermatologist or oculoplastic surgeon who specializes in lasers; they can safely treat this delicate area and get your skin looking smooth and natural again.

Julian De Silva, MD · Answer

I am sorry you feel more insecure than before; that is hard, and worth addressing properly. A couple of honest points. At almost a year you are at the stage where the result is largely settled, so what you see now is a fair basis to assess. A crease that does not match the other side can sometimes be refined with a small revision, but revision upper-lid surgery is delicate and is best done by someone experienced, and ideally after a frank conversation with your original surgeon first, since they know exactly what was done. On the crepey skin, that is a change in skin quality rather than something the blepharoplasty caused directly, and it is treated differently, with careful resurfacing or good skincare rather than more surgery. I like CO2 laser for this., I was not your surgeon, so I am speaking generally and cannot tell from photographs how much is fixable. A focused in-person examination of the crease, the scar and your lid closure would tell you what is realistic. Please do not lose heart; this is usually improvable. Best of luck

Post upper blepharoplasty crepey eyelid skin and scar concerns - how can I treat this? (Photos)

Answers (5)

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