Scar during double eyelid surgery and its effect

Incision double eyelid surgery can create a scar during surgery. Every time when we operate, internal scar occurs. It is the degree of how much scars form during surgery that matters.

There are many things to consider when we think of scars. What is a scar? Why does it form?
How can it cause a negative effect after double eyelid surgery?

A scar is made of collagen. Specifically, it has more type 3 collagen than type 1 collagen. These collagen tissues form as an end product of inflammation. Then why does it form after incision double eyelid surgery? Perhaps it is a body’s defense mechanism against anything that is not “natural.” During an incision double eyelid surgery, the surgeon often cuts through many layers of the eyelid tissue to make the double eyelid fold. Specifically, the levator aponeurosis or the tarsus (which is in the deeper layer) is exposed to connect the eyelid skin to one or both of these structures. As incisions occur into the deeper layer, bleeding occurs. In order to stop bleeding, heat must be delivered to stop these bleeders. And as heat is delivered, it causes tissue burn. We should stop and think what a burn it. A burn is a scar. In addition, after the double eyelid surgery, the small amount of bleeding can occur postoperatively once epinephrine wears off. Although blood is a natural part of our body, blood belongs in the blood vessels. When blood is outside of our vessels, our immune system clears the blood products by means of the white blood cells. And this mobilization of the white blood cells is what also causes inflammation and scar formation.

So once scars form in incision double eyelid surgery, the scars do two things. One is that it adds weight to the eyelid. This excess weight makes eyes feel heavy. Another thing the scar does is it impedes the lymphatic drainage of the eyelid. Therefore, the eyelid will appear swollen for a prolonged period of time until the scar matures and soften. The fluid accumulation in the eyelid also adds weight to the eyelid. Thus, with excess weight from the scar and the fluid accumulation, the eyelids will feel heavy and the eyes will not open fully.

This is one of the reasons why an eyelid ptosis surgery is performed: to counter the above-mentioned effect of excess weight. However, what would be more optimal is to not create eyelid scar in the first place during incision double eyelid surgery. What is exciting about the advanced incision double eyelid surgery performed by Dr. Kenneth Kim is that minimal internal scar is formed. This is because the deeper layer is not touched and the double eyelid fold is made without having to enter into the deeper layer to create the double eyelid fold. In addition, excess weight is removed by removing the skin, superficial muscle, and fat during double eyelid surgery. Lastly, many patients have an epicanthal fold. This epicanthal fold is a strong internal connective tissue that impedes inner eyelid opening. By performing epicanthoplasty and therefore removing the contractive force, the eyes open more easily.

In summary, scar tissue formation should be minimized during any surgery including double eyelid surgery. Scar formation often occurs during incision double eyelid surgery because eyelid tissue is very vascular (a lot of blood vessels). By minimizing bleeding, natural and beautiful double eyelids can be formed.