Thank you for your question.
You are 5 months out after Asian eyelid surgery and with your eyes closed, you showed an area
of scarring that you refer to as hypertrophic scar and that you’ve undergone steroid injection
as well as silicon sheet.
And you are asking are there any other options and you are asking about the PicoSure laser.
Well, I can surely give you my perspective on a situation like yours.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years.
I do specialize in Asian eyelid surgery amongst the other eyelid specialty areas that I do
and I can certainly share with you a kind of an approach that I have as people are healing
from this type of surgery.
So first, it is important to understand that healing after eyelid surgery can take up to
a year and even longer to really appreciate true surgical healing.
So 5 months may be fine in terms of cosmetic appearance when your eyes are open and you
can look pretty good.
But as far as the scars are concerned, it is probably acceptable certainly that you
underwent steroid injection but there is still a lot of maturing and healing going on.
A lot of times, a scar like this which is red or getting thicker and continuously increases
in size will actually soften over time.
Now this is being offered without a physical examination.
But a lot of times, just the normal blinking can actually soften the scars.
Yes, steroid injection can help and depending on your surgeon’s sense of appropriateness
of the steroid injection, I think it is very important that you continue to follow your
surgeon’s guidance.
The general approach has been, in my practice, is to be conservative and observe.
It is extremely rare to have an undesirable thickened scar long-term.
When you think about this type of surgery, the scar is in a place where the stitches
were and so what caused the scarring to occur?
Well basically, as you transition towards the nose, the nasal skin which is a little
bit thicker, there can be some tendency for the scar to appear a little bit thicker.
But generally, the other factors contribute to a thickened scar such as excess tension
are not really an issue with Asian eyelid surgery because you always have to leave enough
skin to fold over.
So that being said, you kind of have to think for yourself how does the scar look relative
to the way it looked a month before.
Does it look better or does it look worse and that’s what kind of guides a physician
as to what to do moving forward.
As far as the question about laser type of procedure and whether it is a PicoSure or
any type of laser, you’re probably thinking about whether a laser is appropriate in scar
management.
Basically, there are two important phases.
When it is early when the scar has a lot of redness, that’s where certain dye laser
or lasers that are attracted to red have some potential value.
And then later, for scarring, a laser may have value in terms of planing down the scar
or reducing it.
I really don’t think that laser has any role in this type of situation.
I don’t think it’s going to be beneficial.
You are creating essentially some type of stimulation that can also result in more scars.
In my experience again, this is a kind of situation where you observe.
You allow the full healing to occur.
If the scar is still problematic, you can do surgical revision or strategic injection
of steroid when appropriate.
When there is any sign of the improvement occurring as the months go on, I think most
of my colleagues would agree to just observe.
So again, discuss this with your doctor.
Try not to get consumed with too much confusion from people who have examined you but at least
understand hopefully from what I’ve discussed some of the thinking that goes to how a surgeon
deals with this type of scar.
So I hope that was helpful, I wish you the best of luck and thank you for your question.