Thank you for your question.
You submitted your question without a photo.
You do describe in the details of your question that you are planning to have a suture technique
for your Asian eyelid procedure to bring the crease level higher and to make it more defined.
And that you do intend in the future to have the incisional method to deal with any sagging
skin.
You express a concern about whether or not the non-incisional technique or suture method
would cause scar tissue as where it will be and will it further challenge the outcome
of a future surgery.
Well I can certainly share with you how I discuss exactly this question with my patients
pretty much every day in my practice.
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.
Asian eyelid surgery using both the non-incisional and incisional methods has been a significant
part of my practice for many years.
And this type of counseling, as I mentioned earlier, is a very important discussion and
certainly this type of question arises.
So we’ll go first over the basic principles of what is intended when you do Asian eyelid
surgery.
And that is basically to create a crease or a fold where a crease is not well defined.
And that is essentially creating a connection, a connection between the skin and the muscle
that lifts the eyelid and that muscle is called the levator muscle like the word elevator,
the word levator.
The differentiation is that when I see a patient and I do an examination and we decide what
kind of eyelid crease they want, essentially what I look to see is there excess fat, is
there excess skin.
And if there is none, then I recommend the non-incisional approach.
Now to respond to the question as to scar tissue, I think it’s very important to differentiate
what a physician’s definition of scar tissue is and a non-physician’s definition.
When people think of the word scar tissue, they often perceive it as a disfigurement
or something that complicates the outcome of anything.
But the reality is that a certain amount of scar tissue as defined medically is a normal
part of healing.
What it basically means is that when we place the skin in a way to attach to the levator
muscle, the suture will approximate or put the skin in place to create this fold.
But what we expect to occur is that eventually, the body forms collagen which is essentially
what we describe as scar tissue to help create those connections such that if those sutures
were to get loosened or require to be taken out for any reason, well the body will still
have a connection there.
Now if you want to talk about volume of scar tissue, well I don't think you can have any
less volume than using a suture technique.
Now the suture technique does vary between practitioners.
I usually use what is three separate areas or three different spots on the eyelid where
I attach a stitch.
Sometimes I will only do one, sometimes I’ll only do two.
But basically, those little areas where the sutures are placed create very little scar
tissue.
And when you talk about the future as far as when you will be ready to have incisional
surgery, I would say as a general rule, the non-incisional technique leans more towards
the younger patients because they don't have a lot of excess skin.
With facial aging, there is a lot of changes including in the skin’s elasticity.
And in those situations, you are of course going to remove some skin.
So understanding that, you can imagine that there are also remodeling changes that would
make this procedure in no way significantly impacting future surgery.
I’ve even done revision surgeries on patients who had suture technique done within a short
period of time like a couple of years and I would go in and do revision surgery and
I will do it like an incision technique.
And I would not really find that those sutures were problematic for the procedure.
There is a lot of nuance in what we do and certainly, unless there is something more
complicated that transpired before any further surgery, it’s not unusual for me to see
a patient who let’s say is in their mid 40s and they had a non-incisional surgery
done in their 20s.
And when I do their surgery and whether it’s another non-incisional or more likely to be
an incisional procedure, I don't really find there to be that much of an issue that they
had this previous operation.
Again, there is definitely variations.
Some doctors use different types of stitches that can maybe create more inflammation compared
to others.
Some maybe are more aggressive about different ways to anchor the skin.
So I think you can certainly discuss this with your doctor.
But I think it’s not likely that it would be an issue in terms of future planned surgery
given the limited amount of trauma that occurs with non-incisional Asian eyelid surgery.
So I hope that was helpful, I wish you the best of luck and thank you for your question.