Keloid or hypertrophic scar formation in double eyelid surgery

Patients are often concerned about potentially forming keloid or hypertrophic scars after double eyelid surgery.  It is a valid concern as often these patients have developed keloid or hypertrophic scars in other parts of their bodies.  But first, let’s discuss the difference between a keloid vs. hypertrophic scars.

A keloid is a raised scar that forms within and outside of the incision area.  A hypertrophic scar is a raised scar that is within the incision area.  In either case, keloid and hypertrophic scars do not form in double eyelid surgery.  This is because eyelid is a “privileged” area where excess scar formation does not occur.  One main reason for not forming excess scar formation after double eyelid surgery is that the eyelid skin is very thin. One may wonder why they have seen scarring after incision double eyelid surgery.  This is because the double eyelid fold formation was performed with unequal tension along the double eyelid fold line or simply the folds were all placed too deep.

However, there is one area where hypertrophic scar can form.  And that is at the epicanthal region.  In this most medial / inner aspect of the eye, the skin is thicker.  And the process of epicanthoplasty involves removing excess skin.  Therefore, there is more tension upon closure and tension equates to increase a likelihood of scar formation.   Thus, epicanthoplasty must be done with extreme care to avoid hypertrophic scar formation.