How Hooded Eye Surgery Scars are Minimized

People who are considering cosmetic hooded eye surgery, also known as upper blepharoplasty, are concerned about visible scars after the procedure. This is an understandable concern, as people are concerned that the scar from the incision for excess skin and fat removal will be visible when they close their eyes. As a specialist in all types of cosmetic eyelid surgery, I can explain how upper eyelid scars can be virtually imperceptible.

I specialize in all types of cosmetic eyelid surgery as an oculofacial or oculoplastic surgeon, including upper blepharoplasty for hooded eyes, Asian double eyelid surgery to create an eyelid crease, and other eyelid surgeries not performed by general cosmetic or plastic surgeons, such as eyelid ptosis correction, and lacrimal gland prolapse.

As an eyelid specialist, I frequently perform revision surgeries to correct the work of other doctors, such as reconstructive upper eyelid surgery for issues such as infection, skin shortage from excessive skin removal, or undiagnosed eyelid ptosis, as well as other upper and lower eyelid revision surgeries.

Hooded Eye Surgery Before and After

Eyelid Surgery Incisions

Scars are referred to as incision lines by surgeons in relation to cosmetic surgery, or any type of surgery, because that is where the surgical incision is made, then sutured after surgery, eventually healed over, and potentially becoming scars. In upper eyelid surgery, incisions are made to access the fat that causes excess volume in the upper eyelids; to remove or excise redundant eyelid skin that causes hooding; to gain access to the levator muscle that may be causing drooping of the eyelids; or to excise skin when needed to form an eyelid crease, as in Asian double eyelid surgery.

Eyelid Incisions in Darker Ethnic Skin

Patients with darker skin have a higher risk of visible scarring after upper eyelid surgery. Darker skin can range from olive skin in Mediterranean skin types to darker Pacific Islander and African skin types. Since skin incisions cannot be avoided in upper eyelid surgery as they can in lower eyelid surgery, tension when closing the incision is critical in preventing visible scarring. When the tension in closing any incision is too tight, the skin in the incision can stretch, revealing a widened scar. The widened scar can be avoided by limiting tension when the incision is closed.

When the upper eyelid is closed, the incision line or scar can be blended to look like a normal fold of skin. When the upper eyelid is closed, people who have never had upper eyelid surgery have a raised line of skin visible. The visible eyelid crease is formed by where the eyelid folds when the eyes open.

Double eyelid surgery is performed on people who do not have a natural eyelid crease, such as people of Asian descent born without a defined eyelid crease, also known as a monolid. The crease is formed by first excising excess skin and fat that prevents the formation of an eyelid crease, and then sewing the eyelid skin to the levator muscle, which is the muscle that lifts the eyelid.

In non-incisional double eyelid surgery, no fat or skin is removed, but a suture is still placed in the same area so the skin folds when the eyes are closed, resulting in a visible eyelid crease. This fold is also created with hooded eye surgery. Sutures are used to close the incision after the excess eyelid skin that causes hooding is excised, and the sutures are placed where the eyelid skin folds when the eyes are open. The scar is indistinguishable from the natural eyelid fold by blending the incision line where the eyelids would normally have this fold line.

Importance of Post-Operative Healing

Post-operative healing is also essential for minimizing the appearance of the eyelid incision. I recommend to my patients that they use antibiotic ointment on the incision for the first two days after surgery, followed by a petrolatum-based ointment like Aquaphor on the third day. Prolonged use of antibiotic ointment can cause an allergic reaction or contact dermatitis, which can aggravate swelling, redness, and prolong healing. On the third day, switching to a petrolatum-based ointment like Aquaphor to create a moist environment that aids in healing.

Cold compresses are used to reduce surgical swelling for the first two days after surgery, 20 minutes on and 20 minutes off during waking hours. Warm compresses are used instead after two days to help clear the fluid that contributes to temporary swelling.

Recovery

After the first month of initial healing, the appearance of a swollen incision line improves. Within the first month following surgery, collagen that is part of the healing process becomes disorganized, making the eyelids and incision appear large and swollen.

One month after surgery, collagen becomes more organized, and the collagen fibers flatten, resulting in a less swollen appearance. The incision line on the upper eyelid becomes flatter over time. The incision line on the eyelids can look no different than the natural fold of the eyelids with proper incision closure while minimizing tension on the incision, no issues with surgical healing, and enough time.

Conclusion

Results of upper eyelid surgery, like any other cosmetic procedure, is determined by the experience and expertise of the surgeon performing it. Eyelid surgery is a cosmetic surgery that requires an experienced surgeon or specialist because the margin between successful results and complications is measured in millimeters. The difference with eyelid surgery is definitely in the details, which also includes healing of the eyelid incision, where a natural looking fold or an obvious scar is separated by mere millimeters.

Hooded Eye Surgery in NYC and Long Island, New York

Dr Amiya Prasad is a Board-certified cosmetic surgeon, and Fellowship-trained oculofacial plastic and reconstructive surgeon. To schedule a consultation, fill up the form below or contact any of our offices at (212) 265-8877 in Manhattan, New York City; or (516) 742-4636 in Garden City, Long Island, New York; or Vienna, Virginia at (703) 356-1336.

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