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Minimizing Eyelid Surgery Scars in Darker Skin and Keloid-Prone Skin

People with dark skin, such as those of African, Hispanic, Mediterranean, and Asian origin, are frequently hesitant about having eyelid surgery because of the risk of unwanted scarring such as keloids. Although it is widely recognized that people with darker skin types are more likely to develop these types of scars, I can discuss how I address upper and lower eyelid surgery for darker ethnic skin types in my practice.

I completed my ophthalmic residency in Brooklyn. After completing my oculoplastic surgery training, I worked as a division chief in the same hospital for several years. We serviced a neighborhood that was predominantly African in origin, but also had a sizable Hispanic, and Caribbean population. During this time, I also gained recognition for Asian double eyelid surgery, including primary and revision surgery.

African-american female bilateral upper and lower eyelid blepharoplasty before and after 1 year recovery
African-american female upper and lower blepharoplasty before and after 1 year recovery
Performing cosmetic eyelid surgery, as well as a variety of facial trauma-related surgeries, including lacerations and fractures, provided me with a solid foundation of experience that inspired me to assist my colleagues in understanding some critical aspects of performing eyelid surgery on non-Caucasian patients. With this goal in mind, I wrote a paper called “Ethnic Considerations in Eyelid Surgery”.

Lower Eyelid Surgery: A Scarless Approach

To avoid eyelid surgery scars, my first rule is, “If you can avoid an incision, do so.” For example, I use the transconjunctival procedure in lower eyelid surgery to eliminate eye bags, regardless of skin color or type. This implies that if a person has puffy under eye bags produced by fat pockets that have herniated forward, I will do the surgery from the inside of the eyelids, with no exterior or outside incisions on the lower eyelid. My goal is to make you look like you’ve never had eye bags or eyelid surgery. The art is to maintain the natural form and character of the eyes.

Lower blepharoplasty before and after young woman
lower blepharoplasty before and after

Minimizing Upper Eyelid Surgery Scars

Upper eyelid surgery requires skin removal, which necessitates an exterior incision and suture placement. When it comes to upper eyelid surgery, there are some additional considerations for various ethnic groups. For example, in Asian eyelid surgery, the level of the crease, the possibilities of non-incisional versus incisional, the type of epicanthal fold, and if fat should be eliminated make this type of surgery a specialization within my business.

double eyelid surgery before and after
asian double eyelid surgery before and after female
I discovered that patients with the highest risk of keloid scarring can nonetheless have upper eyelid surgery done successfully. I explain to my patients, who have skin tones ranging from light olive to dark brown, that there are some things they should do to reduce the chance of scarring.
female upper and lower blepharoplasty before and after recovery with PRP under eyes treatment
upper and lower blepharoplasty before and after photo. procedure performed at Prasad Cosmetic Surgery Manhattan NYC

The design of upper eyelid skin removal is crucial. We aim to avoid an incision line that is visible outside the eyes while they are open. The skin closure tension should be kept to a minimum, and the sutures and suture technique are crucial in creating a tiny line that is effectively camouflaged within the natural upper eyelid crease.

I typically conduct upper and lower eyelid surgery under local anesthesia with LITE IV sedation, which allows patients to be more comfortable and recover from surgery faster than general anesthesia. Typically, my patients return to work within a week.

Dr. Prasad performs surgery using LITE anesthesia

Customizing Eyelid Surgery for Different Ethnic Groups

In the early to mid-1990s, I passionately advocated for making cosmetic eyelid surgery more accessible to everyone. Many people approached me, believing that as one of the few oculoplastic surgery experts of Indian ancestry in the tristate area at the time, I would have some understanding of the concerns of people with darker skin. Certainly, this had some substance, but my schooling and subsequent experience served as the foundation for my approach to tailoring eyelid surgery for people of all ethnicities. I hope this information was helpful.
eye bag surgery before and after
eye bag surgery before and after

Blepharoplasty Manhattan, NYC; and Long Island, New York

Dr. Amiya Prasad is a Board-certified cosmetic surgeon, and Fellowship-trained in oculofacial plastic and reconstructive surgery. He has over 25 years of experience practicing in Manhattan and Long Island. To book an appointment, please fill out the form below or call one of his offices: New York at (212) 265-8877; Garden City at (516) 742-4636; or Vienna, Virginia at (703) 356-1336 / (703) 821-2683.

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