By: Robert Yoho, MD

In last month’s post on eyelid surgery, I mentioned that I don’t perform lower eyelid surgery through an incision outside of the lower lid, partly because it tends to cause scarring that can pull the eyelid open and make it dry and itchy. This is a big enough point to me that I wanted to clarify for you exactly how that scarring can happen, and why the approach I like much better (removing the excess eyelid fat through an incision inside the lid) avoids that problem –

Eyelid Scarring – What You Want to Avoid

There are actually two ways that the external incision can cause scarring for Pasadena eyelid surgery patients:

• At the surface, along the incision line, because the surgeon either removed too much skin or stitched the incision too tightly, and/or the patient had a tendency to develop tighter-than-average scars
• Inside the lid itself, within the thin layer of fibrous tissue (”orbital septum”) that is just inside the lid muscle that closes the eye, and just outside the structures that open the lower lid

In my last post I mentioned the second type specifically, since that “septum” tissue tends to scar and contract unacceptably in as much as 25 per cent of patients. Complex operations requiring grafting may be needed to correct problems of this kind. Note that any of these complications are possible with the external incision.

Some surgeons performing eyelid surgery near Los Angeles and Pasadena actually consider it just another “accepted risk” that they don’t feel they can do a lot to avoid. I disagree, which is why I take another approach entirely.

In my opinion, ectropion (the pulling-down of the eyelid because of scarring) is a big enough risk that I’d rather minimize the chances of complications by using the incision inside the lid. This approach to eyelid surgery in Pasadena involves no stitches, no skin removal, and doesn’t require me to cut through that special fibrous tissue at all. I can achieve any necessary skin tightening with laser therapy, which heals quicker anyway, and my patients don’t have to worry about that extra scarring risk.