Can You See Lower Eyelid Surgery Scars Clearly in This Original Photo?

Hello.

I’m Dr. Roy, a board-certified plastic surgeon.

Last year, in 2023, when I tallied only the surgeries I performed over the course of the year, I found that I had carried out a total of 564 lower eyelid surgeries.

During this period, there were no complaints at all about cosmetic satisfaction after surgery, but in fact, there were a total of 4 complaints about lower eyelid surgery scars...

All 4 patients underwent additional scar treatment. Three improved a lot, so treatment was ended, and the remaining 1 patient had surgery at the end of last year, so it was still under treatment because not much time had passed since the operation.

Fortunately, when they came in recently, they had improved a lot, so I remember feeling somewhat relieved. :)

In this post, I’d like to talk about the following three subtopics.

• Basic characteristics of scars
• Comparison with unedited original photos of a patient who recently had lower eyelid surgery
• What the doctor should do to minimize lower eyelid surgery scars
• Also, what the patient should pay attention to

During consultations, I often see many people planning lower eyelid surgery who are worried about the scars left after lower eyelid surgery.

It is an incision made into otherwise healthy skin, so that kind of concern is completely natural.

However. Unfortunately, no matter what type of incision it is, there is no incision method in the world that leaves no scar..

In other words, every incision leaves a scar, no matter how tiny it may be.

Still, even though scars can remain, if the cosmetic improvement after surgery is judged to be greater, then in most cases we proceed with surgery decisively.

This is because the bulging fat under the eyes and the sagging skin are often less attractive than the scar itself.

During consultations, I look at photos taken with a high-resolution camera together with the patient, point out exactly what will improve and what will not, discuss the surgical process, and if there is anything the patient needs to decide, I explain it thoroughly so they can understand and give them the right to decide.

What really makes me feel the reality of the saying that age cannot be hidden is that many people considering lower eyelid surgery at an advanced age often have quite sagging skin along with countless wrinkles. When we look closely together, they are all surprisingly startled, as if they had all agreed to react that way.

The bulging fat under the eyes and the dark shadow beneath it automatically draw the eye when you look at a person’s face. As a result, people tend to pay relatively less attention to wrinkles, so in many cases they do not fully recognize these wrinkles.

And even if a scar remains after lower eyelid surgery, the incision area of the lower eyelid itself is a region where, compared to other parts of the body, scar tissue is relatively less pronounced and heals nicely.

Therefore, when patients who recovered well after lower eyelid surgery, without any special issues, come back for follow-up after enough healing time has passed, I very often find myself wondering where exactly I made the incision.

Let’s look at the preoperative appearance of the case I’m introducing today.

This is a typical case expected to have a high level of satisfaction after lower eyelid surgery.

If you look closely, the amount of protruding fat is quite significant. Because of the excessive shadow created toward the tear trough underneath, a dark under-eye circle is formed. Although it is not severe, there is also some visible pinkish vascular show-through in certain areas.

The incision for lower eyelid surgery is made along the area marked by the red line in the photo.

Sometimes I quietly see patients ask, “Doctor! Please make the incision as close to the eyelashes as possible!!” because they hope no scar will remain.

But contrary to what many people think, if the incision is made too close to the eyelashes, more scarring can actually occur. Making the incision intentionally about 2–3 mm away from the eyelashes helps the suture line heal better and makes the scar less noticeable.

Also, among patients who come in for revision surgery after lower eyelid surgery at another hospital, I sometimes see people whose eyelashes are almost completely gone, as if the follicles were damaged as well because the incision was made too close to the lashes...

Next is a photo taken on postoperative day 10.

If the lower eyelid surgery scar looks like that on day 10, I would dare predict that after about 3–4 months, the scar will be almost invisible.

Let’s look at a comparison shot to see the overall change.

Since it is still day 10 and there is likely to be some residual swelling, things usually become much more natural and prettier after about one month.

As you can see, lower eyelid surgery scars rarely become noticeably visible, but if they do happen to appear, the person who has the scar will probably feel devastated.

There are a few rules that I always follow to minimize scarring.

First, before starting the closure when suturing the skin, the tension must already be reduced so that the skin edges are touching each other.

You should not over-resect the skin out of a desire to erase every wrinkle.

Even during surgery, I go through my own secret skin resection test in order to decide how much skin to remove (there has never once been a case of ectropion) and then determine exactly how much to excise.

Second, if additional procedures such as lateral canthopexy are needed, these help greatly by allowing the lower tissue to be lifted upward as a whole, which reduces the tension between the skin edges.

Third, when making the initial skin incision and also at the stage of excising the sagging skin during surgery, I pay close attention not only to the angle of the knife or scissors, but also to the incision angle itself, using my own angle calculations to make later suturing easier.

Fourth, no matter how delayed the surgery may become or how much it may affect the next schedule, when suturing, I check every single stitch to make sure the skin edges are well aligned and that the height of the sutured skin layers is even. If they do not line up properly, I regretfully remove the stitches and do it again. This process takes more time, but when I think of the patient who will be happier because the scar is less visible, even if it makes my own work harder and takes longer, the joy it gives me is greater. Haha

Next, there are also things the patient should pay attention to in order to minimize lower eyelid surgery scars.

After the incision is made, the skin may look fully healed on the surface after a week, but in reality, healing continues constantly underneath.

I usually consider this healing process to take about 3–4 months on average, and applying lower eyelid scar ointment every day throughout that period is quite helpful.

Also, in the early period after surgery, it is better to avoid smiling with the eyes too much or forcefully squinting so that the muscles around the eyes contract excessively.

In particular, the outer part of the orbicularis oculi muscle around the eye should be watched carefully, because if it contracts with too much force, it can pull the sutured skin in the direction of opening!

Also, you should be careful not to expose the wound to ultraviolet light for a while, and you should avoid rubbing your eyes.

To finish, I’ll briefly organize some basic knowledge about lower eyelid surgery.

Lower eyelid surgery is a cosmetic procedure performed to improve signs of aging, such as bulging fat or fine wrinkles located under the eyes.

This surgery is mainly performed to address problems caused by aging, genetics, or lifestyle habits, such as protruding under-eye fat (and especially in occupations that use sudden grip strength, such as volleyball players; many well-known volleyball players and athletes have visited Roy for under-eye fat repositioning ㅎㅎ) or sagging skin and loss of elasticity.

Through surgery, the skin under the eyes is made younger and smoother. It also helps restore a more youthful and energetic appearance, in other words, it helps with rejuvenation. (Actually, after surgery, most people say they look more than 10 years younger.)

Before deciding on this kind of lower eyelid surgery, consultation and diagnosis with an experienced board-certified plastic surgeon are essential.

Rarely, if I judge that lower eyelid surgery would not help at all, I will advise against having the surgery.

Also, when there is concern about hollowing under the eyes during lower eyelid surgery, I sometimes recommend under-eye fat grafting together.

When I consult patients, I speak honestly about the surgical method, whether surgery is necessary, and most importantly, what results can realistically be expected after surgery.

There can be hundreds of different surgical methods, and in particular, there are quite a few clinics that only “remove” protruding fat during lower eyelid surgery.

However, removing under-eye fat alone can easily cause hollowing, is difficult to remove evenly so it can become uneven, and recurrence, where the fat bulges out again, is very common. (Among patients who come in for lower eyelid revision surgery, more than 50% previously had fat removal.)

To prevent these side effects, I basically perform under-eye fat repositioning together, rather than simple “removal.”

I do not perform under-eye fat removal.

To briefly talk about recovery: the time when major swelling goes down is about 10 days on average, and residual swelling slowly subsides over 2–4 months.

As for bruising, among about 100 surgeries, one or two people may have significant bruising, and in those cases it can take up to 2–3 weeks for the bruise to disappear. However, in most cases, even if bruising does occur, it tends to be so mild that it is not noticeable.

Once again, I want to emphasize that before surgery, it is important to receive a clear explanation of your own condition, understand the expected outcome clearly, and then decide on and proceed with surgery.

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Roy Plastic Surgery Clinic (Line 3, Sinsa Station) Main phone: 02-516-5525

Weekdays 10:00 ~ 19:00 Saturday 10:00 ~ 16:00

Roy Plastic Surgery Clinic complies with medical law. The photos in this post were taken under the same conditions, and are images taken with the patient’s prior consent. Also, depending on the individual after plastic surgery or procedures, side effects such as bleeding, infection, and inflammation may occur, so caution is required.

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