Scarring After my Eye Lid Surgery?
I had upper and lower eye lid surgery 9 weeks ago and I can see a scar forming in both the
upper eye lid area close to the tear duct towards the lower eye lids.
My surgeon told me this does not happen usually.
He injected me with diluted cortisone three times already but I see no difference.
Please help me I am very scared.
I am not happy with the results.
Is this normal?
Thank you
Thank you for your question!
You submitted a question with a photo where you have shown what appears to be the appearance
of webs that results after eyelid surgery from the end of the incision, inner aspect
of the upper eyelids, creating a web.
And what you are describing that your surgeon is treating this with cortisone injection.
So naturally you're concerned.
And I'll give a little bit of perspective on what the situation probably is just with
the photos alone, of course, with the absence of physical examination.
Well, this type of fold or web can happen in different case scenarios.
And probably the most common scenario is when the skin in the inner aspect below the medial
part or the inner aspect of the incision is relatively loose.
So, when the upper eyelid surgery was done, a certain amount of skin was removed and was
closed where it should be but because of some of the dynamics of tension, sometimes a fold
can occur which tends-up the skin.
Now this scenario could be where the transition between eyelid skin and nasal skin and such
that the incision can heal a little aggressively and become thickened.
And other scenarios are such where the incision line in the location can play a role in the
way the skin heals.
So, typically, this type of web development in the inner aspect of the eyelid is generally
managed conservatively.
And by conservatively, it is generally through massage and through, like your surgeon is
doing, some type of steroid or anti-scarring injection.
Now, this does require some time and observation.
Generally, when I see patients who have this, and I would wait until a certain amount of
healing has occurred to ensure the most active part of healing, where the beginning of the
wound-healing cycle, the initial healing process, the collagen remodeling is such that things
are beginning to get a little tight and there's a lot of extra collagen until there's a softening
or a change or remodeling of the collagen.
So usually, that's several months after surgery.
If I were to approach someone like yourself, if you were to come to my office having this
history, having done surgery elsewhere and then having this issue, I would probably wait
around 6 months before pursuing a different procedure in order to flatten those out.
Now, just for your education, the procedure that is done when there is a web is something
called z-plasty.
Now z-plasty is taking advantage of certain geometric rules such that when the skin has
relative shortage about 1 dimension that we can move skin in such a way that elongates
of gives an absolute amount of more skin to compensate for the tension.
Now that is looking further into the future.
But a far as your question is concerned about how things are being managed, certainly your
surgeon is doing what most cosmetic surgeons would do in a similar situation.
So I think that in this point, you continue communicating with your doctor, continue complying
with the follow-up care.
If you are not doing massage, discuss with your doctor if massage will be helpful and
if this persists, then a surgical procedure may be necessary such as what is called a
z-plasty.
So I hope that was helpful and thank you for your question.