Why is my eyelid not folding properly after double eyelid surgery?
It has been almost 7 weeks since surgery so I strongly believe it is more than a matter
of swelling.
My right eye is not folding along the stitch line but the left eye is okay.
It folds properly where the stitches were.
What is wrong with my right eye?
Does it seem like I need a reoperation?
What are your thoughts?
Thanks
Thank you for your question!
You submitted some photos and you actually marked on those photos areas where the creases
were intentionally placed and you have a concern about the infolding and the appearance of
the right eye seven weeks after surgery.
It is your belief that this is more than just swelling.
Well, in evaluating the stability of the eyelid crease, it is important to understand that
there are many dynamics that participate in the ultimate outcome of this type of surgery.
When you are the 7-week point, there is still some degree of swelling.
It may not always be apparent.
And I’ll tell you what I tell my patients as this evolves is that the process of fluid
absorption related to surgery happens not only at the superficial level when you can
see it from the eyelash margin or the eyelid margin or the eyelashes all the way to crease
when you see an elevation but also to the deeper levels of the tissue underneath the
skin.
There is a lot of healing going on and the healing process has several stages and that
means that true healing goes on for months and can take up to a year to settle.
I think that when you visit your doctor and review your situations or concerns, if your
doctor feels that the eyelid is still swollen, then any further enhancement surgery is not
likely beneficial when the tissue is swollen.
I always explain to my patients that swelling changes the dynamics of the predictability
of how you place the tissue when doing surgery.
And unless there is a specific indication that requires earlier treatment then it is
usually best to allow swelling to resolve to a reasonable level to the point the surgeon
feels comfortable about going in and doing something to revise the result.
Very often I have seen patients who came in for revision surgery and who had several surgeries
done in a very short time frame between the first surgery with the doctor trying their
best efforts to try to get the patient happy and unfortunately, with every trauma, there
is the potential of scar tissue forming and other issues.
More importantly, swelling is a moving target and therefore it changes the dynamic.
If there are multiple folds, if the crease is not well delineated, it’s usually something
that is amenable to a procedure such as a non-incisional fixation where through the
external from the skin side I should say, little openings are made the connection between
the eyelid and the levator muscle is created.
That’s the principle of most eyelid crease surgery is to create a connection between
the skin and levator muscle.
If there is fat in the way of the space, then you reduce the fat or shift the fat out of
the way in order to create the connection.
So if that doesn’t fixate as well because what we’re counting on when we’re doing
this type of surgery is the body healing where we placed the sutures.
If the sutures does a good job and everything looks good, then when the sutures are removed,
there is a possibility that the skin can detach a little bit and do not create the crisp nice-looking
fold.
So my advice to you is not to lose hope, continue communicating with your doctor.
I’m sure your doctor will see you at regular visits.
In our practice, we see our patients at 1 month, 3 months, 6 months and beyond and the
doors are always open if they have questions or concerns at any time.
Once you have this continuous dialogue and observation and if your doctor takes photos
and documents the progress, it might be easier for you to see where things are going and
not be so worried at a 7th week point.
Surgical healing can take up to a year and swelling can be factor.
Not necessarily what you can see in the outside but what is going on in the inside.
So I hope that was helpful, I wish you the best of luck and thank you for your question!