Thank you for your question.
You submitted several photos and you state in your question that you underwent Asian
eyelid surgery seven weeks earlier and you have a series of questions regarding the current
status of your healing process.
First, you state that you had some steroid injections done which has resulted in making
the eyes more red and you are wondering whether it’s necessary to keep doing those steroid
injections.
You mentioned also that the crease appears to be too high and you are asking will it
go down.
You also stated that the eyelid is covering part of the iris in both eyes and you want
to know if that is going to change and you are asking did the doctor take off too much
skin.
And you state that at the end of the question that you were hoping to get the result that
was like using the tape that you used to create the crease prior to surgery.
Well, I can certainly give you some understanding of where you’re at without complete information
about what type of surgery you had and the exact details of surgery but certainly I can
give you some guidance as to how I explain what the healing is like for Asian eyelid
surgery.
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.
Asian eyelid surgery is a significant part of my practice.
I’ve spent a lot of years educating people about the art of Asian eyelid surgery and
certainly I can give you a little bit of sense of how I make a determination kind of just
looking at what your concerns are starting with essentially the goal of what your eyelids
look like with tape.
So, in the decision making process for Asian eyelid surgery, the first question I have
when I look at somebody and determine that they want to get a double eyelid or double
fold type of crease formed is there is a need to remove skin or remove fat or both.
And basically it is diverging 2 choices.
One is, is it going to be a non-incisional surgery or is it going to be an incisional
surgery.
Now based on that question about that tape, I would suspect that your doctor made the
decision to do an incisional operation for reasons that include probably the presence
of extra skin.
There may have been an opinion that the incisional surgery will maybe work a little bit more
for you compared to a non-incisional.
Both techniques are valid techniques.
It’s just a matter of what is likely to be more successful for you.
And in terms of what apparently is your surgery which was the incisional surgery, now the
question is about the healing process.
So to begin with, whether it’s non-incisional or incisional surgery, the key element of
Asian eyelid surgery is to form a crease is to connect the skin to a muscle called the
levator muscle which you alluded to in your question, the muscle that lifts the eyelid.
Now, in doing so, whether it is non-incisional or incisional, there is a tendency to create
a fair amount of swelling between the crease and the eyelid margin and that results in
making the crease look high.
So that basically addresses your second question where you’re concerned about the height
of the crease.
So I try to explain to all my patients that anticipate that the crease will look too high
early.
Sometimes people like that but usually people want a more natural looking crease and so
it is likely that the swelling will resolve and the crease will get lower.
As far as the concerns about the steroid injections, I’m certain or I’m confident that you
chose your surgeon based on your surgeon’s record of experience of doing Asian eyelid
surgery so I would defer to your surgeon’s decisions as to what justified the steroid
injection.
It is not unusual to have some degree of inflammation as part of the normal healing process.
Now one of the things I do caution my patients about doing because especially during the
first month after any eyelid surgery whether it is Asian or non-Asian eyelid surgery, the
incision can look a little bit red, it can look a little bit bumpy, it can look thick.
And very often, people believe that this is the ongoing undesirable result of scarring
sometimes often commonly referred to as keloid but I explain to my patients that in the beginning
of the first month, we look at wound healing.
This is a time of a lot of collagen placement, a lot of inflammation and processes that can
create the incision to make it look a little bit bumpy and maybe a little bit red.
Now even with that knowledge, a lot of people take the advice of well-meaning friends and
family and they’ll put things like vitamin E or cocoa butter a little too early and they’ll
end up causing more inflammation.
A lot of these over-the-counter scar prevention creams have preservatives and oils that can
actually be irritating.
So whether or not you did that, if your surgeon felt that the incision may have look a little
bit more red than they were comfortable with, steroid injection is obviously of value.
Let your surgeon guide you.
I think it is very difficult for any doctor to just come in and just make an assessment
based on just a simple snapshot.
If you are doing your follow-ups with your doctor, your doctor will be the best judge
of how things are going.
In terms of the eyelid covering part of the iris, that can be a combination of factors.
One is the physical weight of swelling along the margin between the eyelid margin and the
crease.
The swelling can cause something called mechanical ptosis.
A little bit of extra weight on the eyelid pushes the eyelid down.
Number two, just the fixation onto the levator can have some degree of tethering effect which
can affect the eyelid height but generally that is temporary and resolves with swelling
resolution.
And as far as the question you are asking did the doctor take too much skin, well generally
speaking with Asian eyelid surgery, I think most doctors who perform the surgery tend
to be conservative when it comes to taking out skin.
I think anyone who does Asian eyelid surgery with any significant frequency basically understands
that it is not usual, unless someone who is considerably older, it’s usually not about
taking out a lot of skin, usually anywhere from 2-4 mm of skin in terms of width and
you’re taking off enough skin so that you have just the right amount of overlap of the
fold in order to look natural.
So the odds are in your favor that your doctor didn’t take too much skin and again this
is an ongoing discussion between you and your doctor.
So, I think that the take home message is continue following up with your doctor and
have some confidence in the follow-up process and the management.
Surgery is a single event but management afterwards especially if there is any degree of inflammation
or swelling that is maybe slightly outside of the norm but I think in general, most of
your healing process is as expected and that it’s only the dealing with the incisional
redness that may be the area of concern that your doctor is clearly monitoring appropriately.
So I hope that was helpful, I wish you the best of luck and thank you for your question.