Eyelid Surgery Scars: What Seattle Patients Need to Know

Blepharoplasty has a reputation for being one of the most discreet procedures in facial plastic surgery. When done well, the eyes look more awake and less heavy, and most people around you only notice that you look rested. Still, nearly every patient who sits in my Seattle office asks the same question: where will the scars be, and how visible are they? The short answer is that eyelid surgery scars are usually among the easiest to hide on the entire face. The longer answer is worth understanding before you schedule your consultation or step into an operating room.

Where scars actually sit

Upper eyelid incisions tuck into the natural crease of the eyelid. When your eyes are open, the crease hides the line. When your eyes are closed, the scar blends with a shadow that exists in that fold anyway. For most people, that crease sits 7 to 10 millimeters above the lash line. There is nuance here: a surgeon will set the incision height to match your anatomy and your goals, not a fixed measurement. Someone with hooded lids may have a lower crease than someone with a deep, defined crease. The placement should follow your eyelid’s arc, taper inward and outward, and stop before it runs too far toward the nose or out toward the crow’s feet.

Lower eyelid scars depend on the plan. If the goal is to remove or reposition fat without skin excision, the incision can be made on the inside of the lid, a transconjunctival approach. That leaves no external scar. If you need skin tightening, the incision is usually placed just beneath the lash line, following the fine wrinkle that already lives there. In well-healed cases, that subciliary scar looks like a faint, pale thread that sits in a line of natural texture.

I often see patients who worry that their scars will extend into the cheek or out toward the temple, like a cut made by a ruler. Good eyelid surgery rarely does that. The incisions are deliberately short, curved to match the eyelid’s natural shape, and designed to disappear into existing anatomic lines. A lower lid incision placed too low or carried too far laterally is more likely to be noticed and can even pull the eyelid down during healing, which is exactly the problem we work to avoid.

Why eyelids tend to scar well

Eyelid skin is the thinnest on the body. It carries little tension, has a robust blood supply, and heals quickly. That is the perfect recipe for fine scars. Compare that to incisions under tension, like on a shoulder or the front of a knee, where thicker, more aggressive scar tissue forms as the body fights to keep the wound closed. On the eyelids, tissue glides freely and closes without a tug-of-war. The result, most of the time, is a line that fades into a soft, almost imperceptible mark within months.

There are exceptions. People who form hypertrophic scars or keloids elsewhere usually heal normally on the eyelids, but a personal history still matters. Ethnic skin type, age, smoking, and sun exposure each affect the look of scars. I have seen patients in their seventies heal more discreetly than some in their thirties, because older eyelid skin can be looser and under less tension. On the other hand, younger patients often have more pigment response, and a pink or slightly brown line can linger longer before settling down.

What a normal healing timeline looks like

Right after surgery your incisions look like fine red lines. Some puffiness and a halo of bruising around the lids are expected. By day five to seven, stitches are usually removed if external sutures were used. Swelling peaks around day two or three, then recedes. Bruises move with gravity, drifting from the inner corner down toward the cheek over a week or so.

By three to four weeks the raw pink begins to mellow. The lines can look a bit firm or raised to the touch, which often worries patients. That firmness typically reflects early collagen deposition and resolves as the scar remodels. At two to three months most people rhinoplasty before and after call their scars faint. The color continues to fade for six to twelve months. In fair skin the line often becomes nearly colorless. In darker skin you can see a lightened or slightly darker track for a while, which blends over time.

A real-world example: a 58-year-old Seattle patient with upper lid heaviness and lower lid bags underwent upper blepharoplasty and lower lid transconjunctival fat repositioning with light skin resurfacing. At day seven, her upper lid creases were reddish, the lower lids had no external incisions, and there was mild yellow-green bruising along the cheek. At six weeks, the redness had softened to pink, and with eyes open the crease lines were undetectable in conversation. At six months she needed good lighting and a magnifying mirror to find any evidence of surgery.

Choices that influence the scar

Technique matters. A precise incision that follows the actual crease, conservative skin removal, meticulous closure with fine sutures, and careful handling of tissue all help. Fat management plays a role too. In the lower lid, removing too much fat can hollow the eyes and draw attention to the lid, even if the scar is well hidden. Many surgeons today favor repositioning the fat pads to smooth the lid-cheek junction, rather than simply taking them out.

Energy devices during surgery are a double-edged sword. Bipolar cautery helps control bleeding and keeps the field clean, but overuse can add thermal injury that the skin must repair, which can prolong redness. CO2 laser resurfacing around the lower lids can tighten fine lines, but needs to be balanced so that the skin has the elasticity it needs to heal without contraction or persistent color change. I tend to combine light resurfacing with conservative skin pinch techniques for the right candidates, especially in Seattle’s fair-skinned population where sun damage contributes to creping.

Surgeon judgment shows up in scar length and placement. In an upper lid, for example, ending the incision slightly short of the lateral edge of the eye can prevent a telltale extension into thicker skin, while still allowing enough access to remove excess tissue. On the nasal side, staying just shy of the thick tissue near the root of the nose prevents puckering. It’s a series of small decisions that add up to a nearly invisible result.

Seattle’s climate and day-to-day healing

People often ask whether our cloudy weather helps scars. Clouds don’t block ultraviolet light enough to skip sun protection. Seattle’s long summer days and reflected light off water can surprise you. Fresh scars love to darken with UV. It is easier to avoid issues than to correct them. Patients who have surgery in late winter or early spring still need to commit to sunglasses and sunscreen once they head outdoors. On cool, windy days, wraparound glasses help not only with sun but also with tearing, which can make early incisions feel sticky.

Indoor life matters as well. Forced air heating in winter dries the eyes. A lubricating drop can make the first two weeks more comfortable and reduce the urge to rub. If you work downtown and walk the blocks between Pioneer Square and First Hill, give yourself a few extra days before braving the breeze. Small habits like dabbing, not wiping, and keeping a clean pair of sunglasses by the door do more than you might think for the first ten days.

What you can do to help scars fade

I coach patients to do less, not more, in the first week. Cold compresses during waking hours, ten minutes on, ten minutes off, reduce swelling. Keep the head elevated on two pillows for the first few nights. Use the ointment prescribed for the rhinoplasty services Seattle incisions, and keep your hands clean. Skip makeup on the incisions until your surgeon clears it, usually after suture removal and closure of the incision edges.

Once the skin has sealed, gentle scar care can start. A bland moisturizer keeps the area supple. I prefer patients avoid perfumed products and essential oils on fresh scars. After two to three weeks, most surgeons approve starting silicone gel or silicone sheeting. Silicone helps hydrate and modulate collagen, which can reduce thickness and improve the feel of the scar. Sun protection is non-negotiable for several months. A mineral sunscreen with zinc or titanium around the eyes, reapplied if you are outside more than a couple of hours, makes a visible difference at the six-month mark.

Massage has a place, but timing is everything. Too early and you may irritate the tissue. Too aggressive and you can inflame the scar. Light fingertip circular massage for thirty seconds, twice a day, starting around three to four weeks if approved, often softens any mild firmness. If you wear contacts, give your eyelids a few weeks of healing before you start the in-and-out routine again, since that repeated pull on the lids can irritate the incisions.

When scars need a little help

Even ideal surgery can meet unpredictable biology. If a scar stays red longer than expected, a pulsed dye laser session or two can quiet the vessels. If a small bump forms where a suture dissolved, a tiny steroid injection can flatten it. If a lower lid incision heals with a slight line of texture, light fractional laser or microneedling at three to six months can smooth it out. These are office-based touch-ups, measured in minutes, that can tip the balance from good to excellent.

A more significant issue is eyelid malposition, such as slight ectropion where the lower lid turns out. That is not a scar problem alone, but it can be related to how the skin and supporting structures were managed. Early recognition matters. Taping, massage, and lubrication can help many minor cases. For persistent laxity a small lateral canthopexy or canthoplasty can restore position. I bring this up not to alarm, but to acknowledge that experienced surgeons plan to avoid these issues and also know how to fix them when they arise.

Real expectations and the mirror test

Most patients will have an observer’s paradox at one to two weeks: you will see everything, and no one else will see much. I encourage people to test this. Walk into good afternoon light and look straight in the mirror. With eyes open, you should barely see the upper lid line even when it is fresh. Close your eyes halfway and you will see it more. This is the best way to calibrate your expectations. Makeup can camouflage any remaining pinkness after ten to fourteen days if your surgeon approves, but many patients are comfortable in public without it by the end of week two.

Photos on your phone are not neutral. The forward-facing camera tends to brighten and flatten shadows that help disguise scars. If you plan to judge your healing, use the same setting, same light, same distance, and take side-by-side photos weekly. Watching the gradual blend is reassuring.

Specific questions Seattle patients ask

Can I combine eyelid surgery with a facelift or necklift? Often, yes. Many patients choose to address the eyes along with facelift surgery to harmonize the upper and lower face. When done together, recovery timelines overlap and you avoid two separate downtime periods. Scar behavior is still favorable. Facelifts carry incisions around the ear and into the hairline, while eyelid scars stay in the crease or lash line. Each area heals on its own clock. Swelling from a facelift can hover near the lower lids, so I advise extra attention to head elevation and compresses in those cases.

What about combining with rhinoplasty? Eyelid surgery and rhinoplasty target different regions, but they can be paired when there is a compelling reason. The trade-off is more swelling in the central face. If you rely on glasses, remember that a fresh rhinoplasty may limit nose support for frames. Plan for lightweight, cheek-supported readers or temporarily heavier reliance on contacts to avoid pressure on the nasal bridge while your nose heals. The eyelids themselves do not mind that partnership, but logistics matter.

Will people notice my scars on video calls? Under typical home office lighting, no. Ring lights can flatten features and sometimes bring out a slight sheen over healing skin, so a matte mineral sunscreen and a softer light angle help. Choose a light source just off to the side rather than straight on. Most of the time, colleagues will comment that you look rested, not ask what you did.

Does brow position affect eyelid scars? Yes, in the sense that low brows can crowd the lid. In some patients, upper blepharoplasty alone can over-thin the lid if the brow remains heavy. That does not harm the scar, but it can exaggerate the fold and call attention to the area. In others, a small lateral brow lift or neurotoxin to relax a strong corrugator helps open the eye with less skin removal. The goal is balance, not chasing a crease.

Lifestyle habits that nudge healing the right way

Seattle’s coffee culture is alive for a reason, but caffeine can increase early swelling if it pulls you into a dehydrated pattern. Aim for water first thing in the morning, then coffee. Salt during the first week acts like a sponge. If sushi is your comfort food, choose wisely and load up on water and potassium-rich sides. Gentle walks around Green Lake are better than long runs for the first two weeks. Heavy lifting can push blood pressure up and feed bruising.

Sleep plays a quiet role in how scars settle. Back sleeping with a couple of pillows keeps the eyes above the heart and reduces morning puffiness. If you share a bed with a restless dog or a toddler who likes pillows, consider the guest room for a few nights. It is a small investment that often avoids accidental bumps to the eyes in the crucial early window.

If you smoke or vape nicotine, your risk of delayed healing rises. Nicotine clamps down blood vessels and robs the skin of oxygen right when it is trying to stitch itself back together. The best results I see come from patients who pause nicotine two to four weeks before and after surgery. If you need help with that, ask early. Your primary care physician or a smoking cessation program can be an ally.

How scars differ among upper, lower, and revision cases

Upper eyelid scars are usually the most forgiving. The crease hides the line, and the anatomy is consistent. Lower eyelid scars can be invisible when a transconjunctival approach is used, and nearly invisible with a well-placed subciliary incision. Revision cases deserve special attention. If you have had previous eyelid surgery, the scar may need to be re-excised or adjusted. The more times an incision is opened, the greater the chance of thickness or color change, although eyelids still outperform most other areas. A careful plan that respects blood supply and avoids over-thinning the skin is essential.

Scars also behave differently in patients who have had prior energy-based treatments around the eyes. Aggressive resurfacing or radiofrequency can change texture. A gentle approach to skin removal and a more conservative tightening plan reduces risk. Your surgeon should map out where previous treatments were concentrated and adjust accordingly.

Choosing the right surgeon for subtle scars

Training and repetition shape outcomes more than any single trick. Look for a facial plastic surgeon or oculoplastic surgeon who shows a series of standardized, close-up eyelid photos with eyes open, eyes closed, and in three-quarter views. Ask where the incisions will be, how they will be closed, and what their plan is if a small suture bump forms or if redness lingers. I pay attention to how a surgeon talks about trade-offs. If someone promises no scar, I worry. If they explain how the crease hides it, how your skin type behaves, and what steps they take in the operating room and after, that is a good sign.

It helps to ask about caseload. A surgeon who performs eyelid surgery regularly, not just occasionally during a facelift week, tends to have a system for consistency. The instruments matter too. Fine, sharp blades or precise laser incisions, 6-0 or 7-0 caliber sutures, and careful knot placement keep tissue trauma down. That does not guarantee perfection, but it stacks the deck.

The bottom line on visibility

If you are a typical candidate, here is what to expect. At one week, someone across a coffee shop may notice a hint of pink at your upper lid crease if you look down. At two to three weeks, they will not. The subciliary lower lid scar usually reads as a faint line of texture rather than a line of color, and only at close range. The transconjunctival approach leaves no external line at all. By three months, most patients forget to think about their scars. They are too busy answering questions about whether they changed their glasses, went on vacation, or started sleeping better.

That outcome happens by design. Natural eyelid lines, light-handed technique, aftercare that respects the biology of healing, and a little patience do the heavy lifting. Scars will always be present in the literal sense. The aim is to make them feel functionally absent in your real life.

A quick patient-facing checklist for better scar outcomes

Wear sunglasses outside for at least six weeks and use mineral sunscreen around the eyes once incisions have sealed. Use cold compresses in the first 48 hours, keep the head elevated, and avoid heavy lifting for two weeks. Start silicone gel after your surgeon clears you, usually around two to three weeks, and keep the area moisturized. Skip rubbing, avoid makeup on incisions until cleared, and ease back into contact lenses. If a scar stays pink past eight to ten weeks, ask about a simple laser or steroid touch-up rather than waiting in frustration.

When to call your surgeon

Small worries are expected during recovery, and your surgeon would rather hear from you early. Call if you notice increasing pain after the first few days, sudden swelling on one side, discharge that is more than a little crusting, or any change in vision. These do not necessarily point to scar problems, but they matter for safe healing and peace of mind. Most concerns have straightforward fixes when caught early.

Eyebrow position changes, dry eye symptoms that make you dependent on drops, or a lower lid that seems to pull away from the eye deserve a check-in too. Addressing those early with lubrication, taping, massage guidance, or a minor in-office tweak can prevent longer-term issues that might otherwise call attention to the area.

Final thoughts from the exam chair

If I had to put it in one sentence: eyelid surgery scars are typically subtle, strategically placed, and well tolerated, especially in the hands of a surgeon who lives in this anatomy every day. What you do before and after, from sun behavior to silicone use to how you sleep, plays a quiet but real role. For Seattle patients who balance busy schedules with an outdoorsy lifestyle, planning around the first two weeks makes the rest straightforward. Most people return to work in a week or so, to workouts in two to three weeks, and to not thinking about the incision lines by the end of the season.

Patients often tell me at their three-month visit that the only regret is not having done it sooner. That is usually the best indicator that the scars stayed in the background where they belong, and your eyes reclaimed center stage.

The Seattle Facial Plastic Surgery Center, under the direction of Seattle board certified facial plastic surgeons Dr William Portuese and Dr Joseph Shvidler specialize in facial plastic surgery procedures rhinoplasty, eyelid surgery and facelift surgery. Located at 1101 Madison St, Suite 1280 Seattle, WA 98104. Learn more about this plastic surgery clinic in Seattle and the facial plastic surgery procedures offered. Contact The Seattle Facial Plastic Surgery Center today.

The Seattle Facial Plastic Surgery Center
1101 Madison St, Suite 1280 Seattle, WA 98104
(206) 624-6200
https://www.seattlefacial.com
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