Dear Dr Yang,
5 and a half weeks ago I had upper and lower blepharoplasty, canthopexy plus lower face and neck lift. I am happy with the results of the lower BL and the neck lift but have concerns over other aspects.
I have small hard lumps on the scar lines on the upper eyelid. I do massage them as per PS’s instructions but they do not budge. I have been back to PS who told me they might take a year to go. Close up they are visible. Is there anything else I can do? In addition, the far corners of my eyes feel very tight.
Another problem I have is that the crepeyness on one eyelid is still there. How can that happen? My PS says there is nothing he can do about it.
I had a upper and lower BL 15 years ago with a different surgeon and had none of these problems.
Thank you in anticipation of your advice.
I’m not sure what the hard lumps are on the upper eyelid incisions. If there is a lump at the very end of the upper eyelid incision towards the ear side (as opposed to the nose side) this may be something called a Dog Ear or SCD (Standing Cone Deformity, which may form at the ends of incisions after skin removal.) As they heal, they can become small pimple-like bumps which can protrude out from the surface of the skin, but can can be excised later on under local anesthesia. The main drawback of removing a dog ear, is that it can make the pre-existing incision even longer. This is the first possibility that I thought of, but may not be an accurate diagnosis of what is going on with you.
Another possibility is that after the sutures were removed, the some of the holes left from the suture placements can leave deposits of keratin (dead skin) which looks like small white heads. These are called Milia.These can be pretty hard, and the surgeon can “pick” them out using a small needle to “unroof” a small amount of skin which may be trapping the dead skin deposits (keratin). Sometimes they can get pretty big if they are not opened up. The technique to open them is similar to using a needle to try to take out a splinter. The needle doesn’t go deep into the skin. It only picks open the surface skin, which doesn’t have much feeling and allows the white material to come out. The opening needs to be wide enough so it doesn’t close up and form again.
These are two guesses, but I am just guessing what the small hard lumps may be. Without a real diagnosis of what the problem is, I can’t think of anything else to suggest treatment-wise.
The far corners of the eye feel tight because of the canthopexy. The corners of the eyes are tightened using a very small stitch, which gives the patient a feeling of tightness. This is probably normal since you are still considered early after surgery.
Assuming that the surgeon removed an similar amount of skin on both upper eyelids, if there is remaining crepeyness, it may be due to the fact that the skin above the eyelid crease may be hollowing (losing fat) more on the crepey side than the non-crepey side. Since the skin is stretched over more volume, or more fat on the less crepey side, then the skin looks smoother, and less wrinkly, without actually cutting out more skin on one side than the other.
It doesn’t make sense to me that as people age, they “grow back” the extra skin and fat that they had removed in their prior blepharoplasties. I think as people age, their eye socket rims become more exposed and hollow and this can appear to be extra skin and fat pockets around the eyelids. In some cases of revision upper and lower eyelid surgery, small amounts of additional skin can be removed to get a cleaner result, but without adding some fat or volume back to the eyelid area, the results may not look any younger or as good as after their initial upper and lower eyelid surgery.
Without photos demonstrating the problem areas or a consultation to examine the areas in person, these responses are general thoughts based on my own experience with my patients, but may or may not apply to you specific situation, and should not be considered medical advice.
I hope that these responses will be helpful in your discussions with your own surgeon during post-operative follow-up visits.