Lumpy Scars After Blepharoplasty: Causes, Types, and Healing Strategies
Blepharoplasty, commonly known as eyelid surgery, is one of the most popular cosmetic procedures performed worldwide.
While the surgery can dramatically rejuvenate one’s appearance by removing excess skin and fat from the eyelids, some patients experience unexpected complications during the healing process, including lumpy or raised scars.
As someone who regularly consults with patients facing post-surgical concerns, I’ve found that understanding the science behind scar formation can help manage expectations and improve outcomes.
What causes lumpy or puckered scars after blepharoplasty?
Scar formation is a natural part of the body’s healing process, but sometimes this process doesn’t proceed as smoothly as we’d hope. The delicate skin around the eyes is particularly susceptible to forming noticeable scars.
Several factors can contribute to the development of lumpy or puckered scars after blepharoplasty. The most common causes include tension on the wound edges, inflammatory responses, genetic predisposition, and surgical technique.
When excessive tension is placed on healing tissues, the body may produce more collagen than necessary, leading to raised or lumpy scar formation.
Inflammatory reactions, whether from an infection or an overzealous immune response, can disrupt the normal healing process and result in irregular scarring. Additionally, some individuals simply have a genetic tendency toward problematic scarring, regardless of surgical technique or aftercare.
The surgeon’s technique plays a crucial role as well. Improper suture placement, excessive tissue removal, or inadequate wound closure can all contribute to suboptimal scar formation. This is why choosing a board-certified surgeon with specific experience in eyelid procedures is so important.
What do bad blepharoplasty scars look like?
Identifying problematic scarring early can make treatment more effective. Bad blepharoplasty scars can present in several distinct ways, each with different characteristics and treatment approaches.
| Scar Type | Appearance | Common Location | 🔍 Key Identifier |
| Hypertrophic | Raised, red, and thickened | Along incision lines | 🔴 Remains within boundaries of original wound |
| Keloid | Very raised, extends beyond wound | Rare in eyelids, more common in upper cheeks | ⚠️ Grows beyond original incision |
| Contracture | Tight, pulling sensation | Inner corners of eyes | ↔️ Restricts normal movement |
| Suture granuloma | Small, firm lumps | Random spots along incision | 🔵 Isolated bumps rather than continuous line |
| Wide/stretched | Flat but wider than normal | Lower eyelid | 📏 Exceeds 1-2mm in width |
Most concerning to patients are hypertrophic scars, which appear raised and reddened but stay within the boundaries of the original incision. Unlike keloids, these scars don’t invade surrounding tissue but can still be quite noticeable, especially in the thin skin around the eyes.
Wide or stretched scars occur when there’s excessive tension during healing. These scars may not be raised but appear as wider-than-normal lines that can be visible when the eyes are open, particularly if they fall outside the natural eyelid crease.
What is a suture granuloma after blepharoplasty?
One specific type of post-blepharoplasty complication that creates lumpy scars is a suture granuloma. This condition occurs when the body has an inflammatory reaction to the suture material used during surgery.
Suture granulomas typically appear as small, firm nodules along the incision line weeks or months after surgery. They develop when the body identifies the suture material as foreign and creates an inflammatory response to isolate and break down this material. Sometimes, instead of dissolving completely, the suture creates a localized inflammatory reaction that results in a visible or palpable lump.
These granulomas are usually painless but can be cosmetically concerning, especially in such a visible area as the eyelids. They may appear red or the same color as surrounding skin and tend to be firm to the touch. Some patients report mild tenderness, particularly when applying pressure.
Treatment of suture granulomas typically involves either watchful waiting, as many will resolve on their own over time, or minor procedures to remove the inflammatory tissue and any remaining suture material. Steroid injections can also help reduce the inflammation and size of the granuloma.
Can blepharoplasty cause keloid scars?
Keloid scars represent an overaggressive healing response where scar tissue grows beyond the boundaries of the original wound. These raised, often reddish or darker scars can continue to grow even after the wound has healed.
Fortunately, keloid formation after blepharoplasty is extremely rare. The eyelid region has very thin skin with few sebaceous glands, making it one of the areas least prone to keloid formation. Most surgeons with extensive experience in blepharoplasty report seeing very few, if any, true keloids in this region throughout their careers.
However, this doesn’t mean it’s impossible. Patients with a personal or family history of keloid formation elsewhere on their body should discuss this with their surgeon before undergoing blepharoplasty. Those with darker skin tones statistically have a higher predisposition to keloid formation and should be particularly vigilant.
If a true keloid does develop after blepharoplasty, treatment options include:
| Treatment Option | Effectiveness | Invasiveness | 💉 Pain Level | 🕒 Recovery Time |
| Steroid injections | Moderate to high | Minimal | 🟡 Moderate | ⚡ Immediate |
| Silicone sheets/gel | Low to moderate | None | ✅ None | 📆 Months of use |
| Surgical excision | Variable | High | 🔴 Moderate to high | 📆 Weeks |
| Laser therapy | Moderate | Low | 🟡 Mild | ⚡ Days |
| Radiation | High (last resort) | Moderate | 🟡 Mild | ⏱️ Immediate |
| Cryotherapy | Moderate | Low | 🟡 Mild | ⏱️ Days |
It’s important to note that keloids have high recurrence rates, so combination therapy is often the most effective approach.
How do you break up scar tissue after blepharoplasty?
For patients dealing with lumpy or thick scars after blepharoplasty, there are several approaches to breaking up excessive scar tissue and improving the cosmetic outcome.
Massage is one of the simplest and most effective early interventions. Gentle but firm massage of the scar, once the incision has fully closed (usually 2-3 weeks post-surgery), can help break up forming scar tissue and promote more even healing. Using a clean fingertip or cotton swab, patients can perform circular motions along the scar line for 1-2 minutes, 2-3 times daily.
Silicone-based products have significant evidence supporting their effectiveness in scar management. Silicone sheets or gels create an occlusive environment that hydrates the scar tissue and regulates collagen production. For the eyelid area, silicone gel is typically more practical than sheets due to the curves and movements of this region.
For more established scars, professional interventions may be necessary:
- Steroid injections – Tiny amounts of triamcinolone or other corticosteroids can be injected directly into lumpy scars to reduce inflammation and flatten raised areas.
- Laser therapy – Fractional laser treatments can break down excessive scar tissue and stimulate more normalized collagen remodeling.
- Microneedling – This technique creates controlled micro-injuries that stimulate the skin’s natural healing process, often resulting in smoother, less noticeable scars.
- Enzymatic treatments – Certain enzymes can be applied professionally to help break down excessive collagen in scar tissue.
Starting treatment early yields the best results. Most plastic surgeons recommend beginning scar management strategies as soon as incisions have fully closed, rather than waiting to see if problematic scarring develops.
How do you fix lagophthalmos after blepharoplasty?
Lagophthalmos, the inability to completely close the eyelids is another potential complication of blepharoplasty that can occur alongside scarring issues. This condition happens when too much skin is removed during surgery or when scar contracture prevents full eyelid closure.
The condition ranges from mild (slight exposure when sleeping) to severe (constant inability to close the eyes completely). Beyond the cosmetic concern, lagophthalmos can lead to serious problems including chronic dry eye, corneal ulceration, and vision impairment if left untreated.
Early intervention is critical. Initial treatments focus on protecting the cornea while addressing the underlying cause:
| Treatment Approach | Best For | Duration | 👁️ Eye Protection | 🔄 Reversibility |
| Lubricating drops/ointments | Mild cases | Ongoing | 💧 Moderate | ✅ Fully reversible |
| Moisture chambers/eye masks | Nighttime exposure | During sleep | 💧💧 Good | ✅ Fully reversible |
| Eyelid weights | Moderate cases | Temporary or permanent | 💧💧 Good | ✅ Removable |
| Botulinum toxin | Mild muscle issues | 3-4 months | 💧 Variable | ✅ Temporary |
| Surgical correction | Severe cases | Permanent | 💧💧💧 Excellent | ⚠️ Additional surgery |
For cases related to excessive scar tissue formation, the treatments overlap with those for breaking up scar tissue. Massage, steroid injections, and silicone therapy can help soften contractures that prevent full eyelid closure.
More severe cases may require surgical intervention, which might include skin grafting to replace the excessive amount removed during the initial procedure. Fat grafting can also be used to restore volume in cases where volume loss contributes to the lagophthalmos.
For temporary relief while addressing the underlying cause, moisture chambers (specialized goggles worn at night) or lubricating ointments can protect the cornea from exposure damage. Some patients benefit from botulinum toxin injections to relax muscles contributing to abnormal eyelid positioning.
Conclusion
Lumpy scars after blepharoplasty can be distressing, but they are typically manageable with proper intervention. Understanding the different types of scarring and their causes empowers patients to seek appropriate treatment early, which significantly improves outcomes.
Prevention remains the best strategy choosing an experienced surgeon, following post-operative care instructions meticulously, and communicating any concerns promptly can help avoid many complications. For those already dealing with problematic scarring, a customized approach combining home care techniques and professional treatments often yields excellent improvement.
The delicate nature of eyelid skin means that even well-healed blepharoplasty scars typically fade significantly within 6-12 months. Patience is key, as the final appearance of scars continues to improve for up to a year after surgery. With proper care and intervention when needed, most patients ultimately achieve the rejuvenated, natural-looking results they desire from their blepharoplasty procedure.
Remember that each healing journey is unique, and what works for one person may not be ideal for another. Working closely with your surgeon to develop a personalized scar management plan offers the best chance for optimal outcomes.
Eyelid Surgery in White Plains, NY
Refresh your look and boost your confidence with Eyelid Surgery! Achieve a more youthful, rejuvenated appearance while improving vision and comfort. Book your consultation today and learn about our exclusive offers. Contact us now to start your journey to a brighter, more confident you!
