Delayed Healing After Periorbital Surgeries
21 August 2023 onur
The superficial soft tissues around the eyes possess distinct characteristics. The skin of the eyelids is the thinnest skin on the body. Just beneath it lies the thinnest muscle in the body. The skin and muscle are integrated with each other. There is no layer of fatty tissue between them. The eyelids consist of multiple layers of porous tissues. These layers facilitate the movement of tissues, allow fluids to move freely, and contain numerous microscopic lymph vessels.
This unique tissue anatomy inevitably gets disrupted during eyelid surgeries. Generally, the body swiftly repairs the anatomy to a structure quite close to its original form.
While tissues heal after eyelid surgery:
First, the body forms scar tissue; millions of cells communicate and coordinate within the surgical site, capillary blood vessels regenerate and connect, lymph vessels regenerate and connect, and finally, the initial scar tissue formed is eliminated by the body, and porous (areolar) spaces regenerate.
Sometimes, this repair and reconstruction process doesn’t proceed as outlined in the specifications.
Occasionally, the body produces excessive scar tissue; cellular signaling mechanisms between cells get disrupted, blood vessels or lymph vessels cannot be repaired in due time. And sometimes, the formed scar tissue cannot be eliminated in time. All these factors, when observed externally, manifest as delayed healing.
Sometimes, swelling that should subside within weeks can persist for months, even up to a year. A slight shiny, reddish, and somewhat brownish color change on the skin’s surface can last up to a year.
The eyelid scar, which is expected to become a thin, almost invisible line within the first month, can remain reddish and thick even months later. Scar tissue between tissues can lead to stiffening of the eyelids, their deformation, difficulty in movement, and closure.
Issues during the healing process don’t manifest symmetrically in the right and left facial structures, potentially causing asymmetry.
Delayed healing following periorbital surgeries is often attributed to individual constitution, and an underlying cause explaining the situation may not be identifiable. Rarely, delayed healing can be associated with an infection or a connective tissue disorder that disrupts wound healing processes within the body. The mentioned infections usually stem from microbial agents that are uncommon, slow-growing, and resistant to standard treatments.
Delayed healing after periorbital surgeries poses a significant challenge both for the patient and the surgeon. Patients do not wish to wait for months to see their desired results. Moreover, temporary deformations during the healing process can sometimes result in a more unfavorable appearance than before the surgery. Patients are entirely justified in their impatience. This situation can be a source of profound dissatisfaction, affecting social and professional aspects of life, potentially leading to financial and emotional losses.
Unfortunately, during this process, waiting is often the only option. Delayed healing cannot be resolved through another procedure that damages the tissue (such as injections, surface treatments, surgical interventions, etc.).
Yielding to the justifiable impatience of patients and performing additional procedures with good intentions can worsen the situation and reset the healing process. Blaming the physician who performed the procedure for delayed healing is not reasonable. The human mind often seeks someone to hold responsible in the face of negativity, but sometimes the responsible party is the body itself.
During preoperative consultations, when patients express their desire for “no complications,” I tell them that if they promise their body is resistant to infection or scar contracture, I can guarantee that we won’t experience complications.
Physicians usually recommend waiting for the completion of the proliferative phase of healing, which is around 3 months. This doesn’t necessarily mean that everything will return to normal within these 3 months, but generally, things start to improve in a positive direction during this period. Complete healing might take as long as 12-18 months.
When your doctor tells you that you need to wait, don’t rush to another physician immediately, thinking that they are just stalling you. Remember, the time you need a good doctor the most is when things aren’t going as planned, and a complication arises.
Breaking ties with your doctor because your eyelids aren’t healing at the expected pace and manner might lead to more significant challenges in the long run. After all, no one is eager to take over the treatment of a complex patient from another physician, especially an experienced one known for their expertise.
Around 5-10% of patients experience a healing process that deviates from the norm after facial surgeries. For physicians who perform these procedures frequently, this percentage holds a significance beyond just a number. It represents 1-2 real individuals with whom they share the same concern each month.
In periorbital surgeries, we cannot entirely control delayed healing. However, during the delayed healing process, we can implement surgical strategies that prevent tissue deformities. For example, in every lower eyelid surgery I perform, I anchor the outer connective tissue support point of the eyelid to the bone. This technique, known as canthopexy, prevents deformation of the lower eyelid even if complications related to healing arise. When you perform this maneuver in every surgery, you might be performing unnecessary work for 90 out of 100 patients. However, you protect those 5-10 patients from more serious complications. Similarly, for some patients who seek treatment due to lower eyelid deformities, I make mid-face lift surgery a requirement. This surgery lifts the cheek mass upwards and supports the eyelid from below, preventing the lower eyelid from sagging downwards, even if healing is delayed.
However, sometimes these additional procedures can extend the healing process. If a single eyelid surgery would heal in 2-3 weeks, adding a mid-face lift or canthopexy to the plan can extend the healing time to 4-6 weeks.
At this point, a risk-benefit analysis is necessary. A patient might say, “I’ll take the 5-10% risk and opt for a simple lower eyelid surgery on its own.” But I don’t take those 5-10% risks. This is why the patients I operate on take a bit longer to heal due to the technical scope of the surgery, compared to those who undergo conventional techniques.
There isn’t an article readily accessible to patients on the internet about delayed healing around the eye area. I wrote this article for this very reason. I hope you read it before the surgery. If you’re reading it after the surgery, know that you’re not the first person to go through this process. Don’t lose your trust in your doctor immediately.
Stay with love,