Despite common concerns regarding the rate of healing and the final appearance of the upper eyelid scar created by Asian double eyelid surgery, complaints about scar visibility and thickness are uncommon, as is the need for scar revision.

Some believe that Asian patients show a slightly higher rate of "keloid" formation. If this is true, the phenomenon is expressed rarely in eyelid skin, a "privileged" tissue and the thinnest skin in the body. We have never seen a true keloid form after cosmetic eyelid surgery in any of our patients, Asian or Occidental. Most so-called "keloids" are simply bad scars that result from a variety of controllable external factors such as jagged incisions, imprecise suturing, leaving in sutures for too long, placing dissolving instead of removable sutures, or the use of unnecessarily risky cutting tools (such as the laser) or techniques (such as burying permanent sutures inside of the eyelid or removing excessive skin). In over two decades, the only double eyelid scar revisions we have ever undertaken have been on patients whose primary surgery was performed elsewhere.

Scars After Double Eyelid Surgery
female - 6 months after	male - 10 months after
female - 3 months and 12 months after View scar healing week by week
(Surgery by Dr. Frank Meronk)

"Hypertrophic," or overly aggressive, scarring may occur in rare patients and, in our opinion, seems more related to the fact that Asian patients are generally much younger than their Occidental counterparts rather than due to ethnicity. Even when the healing scar is hypertrophic (redder, thicker, slightly shiny), the final smoothing and maturation, while slower, are equivalent to non-hypertrophic scars.

Use of the laser as a cutting tool is somewhat controversial due to the olive coloration of most Asian skin. Darker skin tones are more subject to pigmentary disturbance after laser incision and are, in our opinion, more safely treated with the low-tech stainless steel scalpel.

Commercial products (silicone strips, gels, creams) intended to lessen or treat true keloid formation have no noticeable impact on normal eyelid healing and are not recommended. Likewise, we do not recommend any nutritional supplements or the routine use of Vitamin E oil. After ten days, an eye cream (any brand) may be applied to moisturize, although this is not required. Basically, healing takes time.

The term "non-incisional" used to describe techniques in which a less permanent crease is created by the placement of internal eyelid sutures rather than full open surgery is misleading. Most "non-incisional" techniques require two to four small skin incisions and/or multiple incisions made on the back of the eyelid. The scars, while small, may be just as noticeable as those from the more definitive incisional technique. Scars from operations designed to reshape the epicanthal fold can be objectionable; epicanthoplasty is thus seldom recommended.