Recovery and Healing
After Asian Eyelid Surgery
Special Considerations in the Asian Eyelid
It is helpful to remember that double eyelid surgery is, in most cases, really two operations (one on each upper eyelid) performed simultaneously. Each side may swell and bruise differently, heal at different rates, and demonstrate some variation in final outcome.
• The position and shape of the crease will evolve during healing. Immediately following surgery, the crease will ALWAYS appear much too high and deep, and its true shape will generally be obscured by distortion caused by sutures and swelling. Once the swelling begins to subside, internal healing will still cause the crease shape and height to stay high and change slightly day to day.
The height of the final crease (that is, the "fold" that is visible to others) is determined not just by the incision but rather by the lowest extent of eyelid skin overhanging that incision. In the photos immediately below, the "crease" appears very high following surgery because only the incision is visible. After final healing, the crease appears lower because the skin above the incision softens and overlaps the surgical cut.
Although crease appearance begins to reach an equilibrium at about two months, some slight swelling persists for at least several months more, and so the approximate final configuration may not be reached for six months or longer. Attempting to evaluate crease position over the first few months after surgery is not only misleading, but may lead to unnecessary concern and worry.
In general, the amount of swelling and the rate of healing varies directly with the aggressiveness of surgery. Tapered creases look more natural faster than parallel creases, and lower creases look more natural faster than medium height creases. Though rarely chosen, high parallel creases take the longest to heal and yield the least natural-appearing final result.
Changes in Crease Height, Depth, and Shape With Healing
(All photos of the same patient; full incisional technique)
Just After Surgery
Six Months Later
• Asian eyelid skin is, as a rule, more "reactive" than Occidental skin. In some patients, the scar from the incision may remain overly red and lumpy for a longer period before maturing to its final state, especially in those with thick oily skin and in the area closest to the nose. Since the scar is mostly buried at the bottom of the crease, such delay does not usually pose a great problem. Full final softening and redraping of the skin over the scar may take take six months or more.
• Formation of the new crease by deep fixation generates an internal pull on the eyelid edge that may sometimes lift the eyelashes to a position that seems slightly higher than desirable. As the internal scarring beneath the new crease softens, the lashes slowly return to a lower position.
• Some final asymmetry between the two creases is the rule rather than the exception, especially when there is noticeble asymmetry before the surgery. In fact, upon close examination some imbalance is present in almost every person in the population, whether or not they have ever undergone eyelid surgery. It is important to remember that final eyelid appearance is influenced by a number of interacting variables including brow position, orbital bone variations, slight ptosis, preexisting skin differences, better tissue healing on one side versus the other, and so on.
• If simultaneous ptosis repair has been undertaken along with double eyelid surgery, the overall period of healing may be extended, sometimes substantially. While much of the lift from the ptosis repair is generally expressed within one to three months, some cases make take longer before the eyelids reach their final height.
• Understandably, patients undergoing Asian blepharoplasty seem to be most concerned about the appearance of the upper eyelid crease. Nevertheless, a revision should be considered only after healing has progressed to near completion (at least 6-12 months) and only if any final asymmetry is judged unacceptable by both patient and surgeon because (1) attempting to "fine tune" a slightly imperfect result is not without risk and (2) some imperfections are almost impossible to fix. Considering revisional surgery prematurely due to impatience may not only compound the existing situation but sometimes create entirely new problems.
Next: The Upper Eyelid Scar
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