It has been almost 7 weeks since surgery so I strongly believe it is more than a matter

of swelling. My right eye is not folding along the stitch line but the left eye is okay.

It folds properly where the stitches were. What is wrong with my right eye? Does it seem

like I need a reoperation? What are your thoughts? Thanks

Thank you for your question!

You submitted some photos and you actually marked on those photos areas where the creases

were intentionally placed and you have a concern about the infolding and the appearance of

the right eye seven weeks after surgery. It is your belief that this is more than just

swelling.

Well, in evaluating the stability of the eyelid crease, it is important to understand that

there are many dynamics that participate in the ultimate outcome of this type of surgery.

When you are the 7-week point, there is still some degree of swelling. It may not always

be apparent. And I’ll tell you what I tell my patients as this evolves is that the process

of fluid absorption related to surgery happens not only at the superficial level when you

can see it from the eyelash margin or the eyelid margin or the eyelashes all the way

to crease when you see an elevation but also to the deeper levels of the tissue underneath

the skin. There is a lot of healing going on and the healing process has several stages

and that means that true healing goes on for months and can take up to a year to settle.

I think that when you visit your doctor and review your situations or concerns, if your

doctor feels that the eyelid is still swollen, then any further enhancement surgery is not

likely beneficial when the tissue is swollen. I always explain to my patients that swelling

changes the dynamics of the predictability of how you place the tissue when doing surgery.

And unless there is a specific indication that requires earlier treatment then it is

usually best to allow swelling to resolve to a reasonable level to the point the surgeon

feels comfortable about going in and doing something to revise the result. Very often

I have seen patients who came in for revision surgery and who had several surgeries done

in a very short time frame between the first surgery with the doctor trying their best

efforts to try to get the patient happy and unfortunately, with every trauma, there is

the potential of scar tissue forming and other issues. More importantly, swelling is a moving

target and therefore it changes the dynamic.

If there are multiple folds, if the crease is not well delineated, it’s usually something

that is amenable to a procedure such as a non-incisional fixation where through the

external from the skin side I should say, little openings are made the connection between

the eyelid and the levator muscle is created. That’s the principle of most eyelid crease

surgery is to create a connection between the skin and levator muscle. If there is fat

in the way of the space, then you reduce the fat or shift the fat out of the way in order

to create the connection. So if that doesn’t fixate as well because what we’re counting

on when we’re doing this type of surgery is the body healing where we placed the sutures.

If the sutures does a good job and everything looks good, then when the sutures are removed,

there is a possibility that the skin can detach a little bit and do not create the crisp nice-looking

fold.

So my advice to you is not to lose hope, continue communicating with your doctor. I’m sure

your doctor will see you at regular visits. In our practice, we see our patients at 1

month, 3 months, 6 months and beyond and the doors are always open if they have questions

or concerns at any time. Once you have this continuous dialogue and observation and if

your doctor takes photos and documents the progress, it might be easier for you to see

where things are going and not be so worried at a 7th week point. Surgical healing can

take up to a year and swelling can be factor. Not necessarily what you can see in the outside

but what is going on in the inside.

So I hope that was helpful, I wish you the best of luck and thank you for your question!