Thank you for your question.
You've submitted two sets of photos before and after your combination surgery of Asian
Upper Eyelid Surgery and epicanthoplasty six weeks prior.
And you’ve described your new questions and concerns about the difference between
the two eyes at this – at this point in time.
Well I can certainly give you some guidance from my perspective from just your photos
alone in the absence of a physical exam.
I’m a board certified cosmetic surgeon and a fellowship trained oculofacial plastic and
reconstructive surgeon practicing in Manhattan and Long Island for over 20 years; and with
a significant focus in my practice on Asian Eyelid Surgery.
And so I can certainly give you some perspective from how I manage my patients and what is
likely going to be the explanation from your doctor.
And I would actually, first and foremost, encourage you to communicate with your doctor.
Your doctor – you chose your doctor to do your surgery because you believed your doctor
was able to deliver on the desired result.
And so it’s – I think it’s a little early to lose faith.
But I’ll give you a little bit of understanding of what phases of healing are and why it’s
important and how it could affect your outcome.
When we talk about surgery, any kind of surgery – but in particular I would say, surgery
which is so precise as it is with Asian Eyelid Surgery, these phases of healing have a very
important role in the impact of long term result.
So what I described in wound healing, there are essentially three – or technically,
four phases of wound healing.
And the first phase is the phase where you just are – everything is being clotted,
the blood clotting phase, the homeostatic phase; then comes the inflammatory phase.
And that’s like the first week.
And that’s when things look more swollen and it looks very red.
And then comes the stage which you're in now, it’s called the proliferative stage.
Now the proliferative stage is the stage where the body is producing collagen and it’s
– it does a lot of activity.
And things have a tendency to get a little bit tight.
I also say – tell our patients that like the upper eyelid incision, it can actually
look thick.
And it’s a time where people want to try to use some of a topical cream like Scarguard
or something of that nature; or something in the over the counter offerings in drug
stores.
But really that’s a normal part of healing.
So we throw in the other variable from the upper eyelid incision – or the upper eyelid
crease whether or not you did a non-incisional or incisional procedure.
I would also say that another part of this equation is the epicanthoplasty.
And the epicanthoplasty is a – is a particular sensitive area because this is an area where
the skin has the tendency to become very thick.
It has the tendency to become tight.
And that may be contributing to the overall asymmetry.
I’m sure, as I do, your doctor probably spent a lot of time planning, and drawing,
and making sure that everything was measured and done appropriately.
But then comes the healing process.
Now, wound healing can go on for a year and beyond.
So that’s the last phase of wound healing called the wound remodeling phase.
That’s where the thickening shifts over to softening.
And at the more cellular level, there’s a lot of activity that’s more – turning
everything into something that’s more natural.
So this would not be the time to necessarily intervene in terms of surgery.
There may be some value in doing some kind of topical massage which you should speak
to your doctor about.
But in – like in the epicanthal fold on the right side, you may want to consider that
as an option to try to soften it.
Because when you think about it, if the skin is getting tighter on the epicanthal fold
on the right side, then it can pull the skin down a little bit more tightly.
So that being said, again, discuss this with your doctor.
I mean I have a very straightforward policy in my practice.
The door is always open.
And we see our patients – for, like Asian Eyelid Surgery, we had one week.
Two to three weeks after that then a month.
And we follow people kind of closely in the first couple of months because this is the
time of transition.
Very often with like a non-incisional approach, you can kind of tell a little bit more easily
what’s going on in the beginning because there’s a – that’s the one variable
of skin incision is not a part of that.
And so you can almost predict a little bit more easily.
But I still say that swelling and wound healing is still a critically important part of this
equation.
If revision is necessary, then you wait.
Typically, when there is less swelling, so your doctor can actually do something.
But then – but right now, we’re getting ahead of ourselves.
Right now, go back to seeing your doctor and seeing what – learning what – what’s
going on.
And it is not unusual for one eye to look different than the other in the beginning
until things start to heal at a more mature level.
And then the symmetry will probably be closer to what was intended during surgery.
There’s kind of a golden rule.
One of my preceptors in – when I was in training, he told me is that if doesn’t
look good in the operating room, it’s not going to look good outside the operating room.
And so that’s kind of how we do our procedures.
We measure and we watch and we – have even patients open their eyes and look.
And we have them sit up sometimes.
You know, a lot of it is to just maximize the predictability.
At the same time, the human body is the human body and there can be subtle natural asymmetries
that are intrinsic.
And then there can be asymmetries in terms of the progress of wound healing.
But as time goes on, things start to balance out.
So I hope that was helpful.
I wish you the best of luck.
Thank you for your question.