How Skin Tension Can Cause Skin Folds after Eyelid Surgery and How to Prevent Them

Описание: A man had upper and lower eyelid surgery and he has observed a scar formation in both of his upper eyelid close to the tear duct area. He was injected diluted cortisone by his surgeon but he could not see any difference.

Dr. Amiya Prasad, an oculofacial plastic surgeon, explains that this type of fold or web can happen in different cases. The most common scenario is when the skin in the inner aspect below the medial part of the incision is relatively loose. This means that a certain amount of skin was removed and because of the dynamics of tension, a fold can occur. This type of folding is most common in the skin between the eyelid and the nasal area. Another scenario is when the incision line plays a role in the way the skin heals - it can heal gently or aggressively until it thickens.

Web development is generally managed conservatively through massage, the use of steroid and anti-scarring injections. This requires some time to work and observation of the scar. When Dr. Prasad sees patients who have this, he would wait until a the most active part of healing has already occurred. Active wound healing occurs when the initial healing process or collagen remodeling begins to tighten the area until the collagen softens after several months after the surgery. He would also wait around 6 months before pursuing a different procedure to flatten the web or scar.

Another procedure that can help with the webbing and scarring is called a z-plasty. This procedure takes advantage of certain geometric rules. If the skin has relative shortage, then the skin can be moved in such a way to give an absolute amount of skin to compensate for the tension and shortage. At this point, Dr. Prasad thinks that the use of steroids is adequate for this woman's case. He would also suggest doing massage of the area, but the patient must first communicate with his doctor if this will be beneficial to his case.

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