Thank you for your question.
You have submitted several very good photos of different views of your eyes up close with
your eyes closed.
And you are nine and a half weeks after undergoing Asian eyelid surgery in which skin and fat
was removed and you also state that you also had some work done in the inner corners typically
what we refer to as epicanthoplasty.
And you are asking if this normal healing and is there anything to be concerned about
as you review where you are in the stage that you are at.
Well, I can certainly give you some guidance about how you are healing.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
I do a lot of Asian eyelid surgery in my practice.
It’s actually an area of specialty of mine both primary and revision surgery.
So I can certainly give you a little bit of understanding as to how I explain this type
of procedure to my patients and what to expect over the several months to a year after surgery.
To begin with, based on the photos you have submitted and without any physical examination,
I think that the overall appearance looks consistent with incisional surgery and the
type of work that you have done.
I think that’s something to get out of the way in the beginning that everything does
look, from the photos, like normal healing.
Now to understand what normal healing is, you have to take into account what is unique
about Asian eyelid surgery.
Well, to begin with, with Asian eyelid surgery, whether it’s incisional or non-incisional,
there is one critical element that has to be part of that surgery and that critical
element is a connection between the skin and the muscle that’s underneath the skin in
the eyelid called the levator muscle.
This is the muscle that lifts the eyelid.
When you are trying to create a crease, you’re basically creating a connection.
Now in your situation, your doctor decided, because of an indication of probably extra
skin and the presence of fat to do an incisional approach.
When that surgery is done, the skin is stitched to the underlying muscle and what you are
seeing is some of the redness and swelling that is typical in a little bit of two months
after surgery.
I always explain to patients who are having Asian eyelid surgery that that space between
the eyelid crease and the margin can really collect a lot of fluid.
And that fluid can create the impression of this crease being higher.
It can be a little bit challenging to see that pace in which the fluid is going away
but it is actually very much typical.
I always tell my patients that you can expect swelling to be present up to a year.
Now it doesn’t mean the same level of swelling.
There is an improvement as time goes on but even at 3 months, you can have a significant
amount of swelling so that you really have to wait out until that swelling goes down
before you see the final result.
Typically, I’ll say it’s about 6 months at which point you can say there’s likely
the more stable appearance of the eyes.
And even though sometimes people will linger with fluid and especially people who have
sinus issues or allergies, that’s likely the time when you can reasonably conclude
that you’re where you should be.
It’s the same thing with epicanthoplasty.
Epicanthoplasty is the repositioning of skin to reveal more of the space where the corner
of the eyelid is.
And so, when you look at the skin, it’s the fold over that inner corner, the inner
canthus is called the epicanthal fold.
So with that, it’s understood that there’s going to be maybe a little bit of redness,
a little bit of swelling.
The skin can look a little bit thick and it can look a little bumpy but that also is very
much normal.
When you understand wound healing, there are several stages of wound healing and the first
month is what’s called the proliferative stage.
This is where the body’s producing a lot of collagen, a lot of blood supply to deal
with this controlled healing process or controlled trauma of surgery.
Beyond that, it goes through what’s called the wound remodeling process and that’s
when fluid diminishes.
The collagen orientation becomes more parallel which means the skin starts to become softer
and flatter.
And so, when we see our patients, we reeducate them continuously about this process.
So we see our patients at one week, at one month, 3 months, 6 months, 12 months.
And basically doing those visits, we have that discussion to help people understand
this.
So it is important that you communicate continuously with your doctor whether it’s seeing your
doctor at the office.
And when you are at the office, make sure you bring a list of questions or bring to
their attention of course what concerns you and get a sense of what to anticipate.
It’s routine for me during consultations to show examples what the healing process
is like so that people have a better understanding.
I would say, as a general rule, a non-incisional swelling can still last a lot less or as long
as incisional but there are always exceptions to that.
So, discuss this with your doctor.
From a collegial standpoint, I can say that it looks like you’re healing as expected
just based on photos alone and make sure you follow your doctor’s instructions and wait
and see what the final result is.
So I hope that was helpful, I wish you the best of luck and thank you for your question.