Thank
you for your question!
You submitted several photos and you’re asking a very straightforward question: could
a small to medium eyelid crease after surgery look like a very large crease?
And you submitted several photos that show significant swelling between the eyelid crease
and the margin.
Well, I can certainly give you some guidance with this question.
I’m a board certified cosmetic surgeon and fellowship trained oculofacial plastic and
reconstructive surgeon practicing in Manhattan and Long Island for over 20 years.
Asian eyelid surgery is an area of specialty in my practice and I can certainly give you
some guidance on what I expect and what I tell my patients to expect after eyelid surgery.
So to begin with, whether it’s a non-incisional approach or an incisional approach to Asian
eyelid surgery, there’s a meticulous planning process that is critical to the success of
the surgery and that’s basically setting the ideal crease of the eyelid when the healing
is done.
Whether it’s non-incisional or incisional, there’s always a certain connection that
has to be made between the skin and the levator muscle.
The levator muscle is the muscle that lifts the eyelid like the word elevator.
Now, to create that type of connection, sutures or stitches have to be placed in a way that
connects the skin to the muscle.
So it is very common to have initially swelling that makes the crease look enlarged.
And basically, it’s almost like a compression where there’s a narrow space where fluid
will collect until the body clears it out and that fluid can be present for weeks to
months.
In rare occasions, it can even go beyond up to a year.
And so, what I tell my patients is that in the beginning, your crease is going to look
high and large and much more than what you wanted.
And sometimes patients will come and be concerned that the swelling on one side is different
on the other side and of course, that’s normal also.
So what I explain is that basically, the first month is usually when the swelling is at its
most.
There are several important wound healing stages that occur in the first month.
From the inflammatory stage to the proliferative stage and then after that, there’s what’s
called the wound remodeling stage and that goes on for a year and even beyond.
But the point is that swelling can really take its time and not that it’s going to
be the same throughout the period of healing but the first month or so, it’s definitely
at its peak but it is not at all unusual to see it still present and lingering into the
second month.
For most of our patients, when I see them at the third month visit, I can see some mild
degree of swelling but socially, it’s usually not that significant.
So to answer your question, is it normal to have a small to medium crease look like a
large crease?
The answer is absolutely yes and in fact, it’s typical.
It’s the rare situation where someone has so little swelling that they would look exactly
the way they would look in 3-6 months as in the first couple of weeks.
It’s just not typical.
During the surgery, when I set the eyelid, I sometimes have the patient open their eyes
to make sure I like the way the crease is folding in but even during surgery, because
of anesthetic, there’s still going to be some swelling.
So that’s why the planning before the surgery and the markings are so important in terms
of measuring and placement but I’m sure the doctor you chose to have your surgery
with inspired enough confidence in you to choose the doctor so I’m certain that this
discussion has already transpired but it’s okay to naturally be reassured.
I would recommend that you continue following up with your doctor.
During your follow-up visits, ask about the degree of swelling if it’s normal and of
course, bring to your doctor’s attention any other concerns you have during this healing
process.
As in our practice, we see people at one week, one month, three months, 6 months and then
as often as time between as any patient needs to come in just to be sure.
It’s a lot easier to make those evaluations in person rather than from a distance.
So I hope that was helpful, I wish you the best of luck and thank you for your question!