Thank you for your question!
You’re asking if, with the photos you submitted, if your eyelids would turn out even although
the incision lines don’t appear to be the same, and that you had your eyelid surgery
performed about 3 weeks ago.
Well, I can certainly give you my perspective on your question.
This is limited in the absence of a physical examination but at least we can go over some
basic principles of eyelid surgery which you did in lieu to your question where you say,
yes you know that things will change with swelling.
So a little bit of background, I’m a board certified cosmetic surgeon and a fellowship
trained oculofacial plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years and Asian eyelid
surgery is an area specialty and I have a lot of experience with this type of surgery
and so I’ll give you some guidance as to how I advise my patients regarding this procedure.
Now certainly, the concerns you have are logical.
As a person who is not a surgeon, you naturally just look at the incisions and wonder if the
future is also going to be as asymmetric as the present.
Well, let’s review for a moment what the basic concept of eyelid crease surgery is
and this is to essentially, create a connection between the skin and a muscle called the levator
muscle.
The levator muscle is the muscle that lifts the eyelid.
And for people who are born with a natural crease, there is a natural connection between
the levator muscle and the eyelid skin.
So whether it’s incisional eyelid surgery or non-incisional eyelid surgery, the goal
is to connect the skin to the levator muscle.
Now, assuming that your procedure did involve removal of skin, you could probably imagine
that there was going to be probably some degree of difference in the amount of skin that was
removed and during the time of the surgery, there’s going to be naturally some difference
in the anchoring as well as the subsequent swelling.
One of the things that I try to help people understand when people come to me particularly
those who come for revision eyelid surgery is that the crease placement by incision doesn’t
necessarily correspond with the ultimate crease of the eyelid.
This applies to Asian and non-asian eyelid surgery.
Although the crease, logically you want the crease to be able to be formed from the incision
because that’s the way the technique is where you are suturing between the skin, the
muscle and then back to the skin, you can probably be confident that when things are
healed up, that your surgeon’s intentions or plans will probably work out as is best
expected.
During surgery, there is always going to be some variability and of course, what I explain
to my patients, is that in the first month in particular, the distance between the eyelid
crease and the lashes or the margin is going to look elevated because of swelling.
The eyelid platform or the place where you typically apply eye shadow is going to look
like it’s elongated or widened and it’s going to look artificially high.
With time, that swelling comes down and an equilibrium and balance occurs.
So I think that most likely, you made your decision to choose your surgeon based on your
perception that the surgeon was experienced with Asian eyelid surgery so I think that
you should, of course, ask the question to the surgeon and I think that your surgeon
may respond by saying that there was probably some degree of asymmetry in the level of the
fixation and the crease height in order to achieve the end result which is to create
the type of fold in the way that’s desirable and most optimal when your eyes are open.
You’ll also appreciate with time that as this incision fades, that the exact placement
of the incision becomes less important.
It’s the healing process that initially people look and analyze and sometimes get
really critical about the way the skin is stitched and how swollen things are with the
desire to predict how things are going to look.
But I always try to explain that wound healing is a process.
That it is very slow when you think about all the things we do in life which is getting
faster every day.
But we are products of evolution and this evolutionary process of healing, you know
if you think about the stages of wound healing.
There’s the hemostatic stage, the inflammatory stage, the proliferative stage and the remodeling
stage.
It’s why a lot of my before and after pictures I take at around 6 months because with the
understanding that there’s going to be a fluctuation and variability.
I’d say that the first month is where you see the most variability and shifting of swelling
but certainly, I think that your question should be addressed directly to your surgeon
and I think that probably when you saw your surgeon at one week or so and having your
sutures removed, you probably raised that question.
And so, in our practice, we see our patients at one week, one month, three months, six
months and twelve months.
However, with situations like Asian eyelid surgery, I’ll see people at least after
the first week.
When sutures are removed, I see them monthly just to help guide them through the process
of the healing stages so that they don’t feel that things are happening in a way that’s
not under control.
So again, I recommend that you talk to your doctor about this situation and I think that
you’re ultimately going to wait to see how things heal up and then make decisions strategically
at that point.
So I hope that was helpful, I wish you the best of luck and thank you for your question!