Your eyes, your face, our passion. This slogan is displayed on the official website of the American Society of Ophthalmic Plastic and Reconstructive Surgery, of which I am a proud member. Standing in agreement with this bold statement, I firmly believe that to be a great oculoplastic surgeon, one must be passionate about this distinctive specialty. This passion explains why we dedicate 13-plus years, from medical school to fellowships, to training intensely to be the best in the field.
Operating on another human being is a tremendous responsibility. Unfortunately, current social media trends minimize the true surgical nature of these cosmetic procedures. It is common for patients to conclude that cosmetic eyelid surgery is relatively simple, thus assuming that recovery will be swift and surgical results quickly observed. The same media emphasizes quick fixes over patient safety and reproducible outcomes, giving people the impression that we operate with a wand, not a scalpel, to quote Rod Rohrich, M.D, a plastic surgeon based in Dallas.
The preoperative consultation is key to the success of your operation
A patient’s satisfaction with an oculoplastic procedure is based on many variables, many of which are under the surgeon’s control. Careful preoperative analysis of the patient’s anatomy and a strong understanding of the patient’s goals are imperative for selecting the safest and most effective procedure to achieve the best outcome. Sometimes, the safest approach will involve a very complex operation, but the right method is often simple and straightforward.
Having said this, oculoplastic surgeons understand that patients’ wounds heal differently. A tissue’s reaction to surgical trauma can be somewhat unpredictable; therefore, the surgeon does not have total control over the ultimate result. Experienced surgeons are fully aware of this fact and reinforce honesty regarding potential complications, limitations of surgery, and the possibility of a touch-up procedure to improve scars or asymmetry.
Why and when to do a touch-up after eyelid plastic surgery
Surgical reinterventions, or touch-ups, are integral to what we do as surgeons. Although the touch-up rate in my clinical practice is low, I discuss this possibility with all my patients because I believe it is part of establishing an honest practice and rapport with patients.
The first point regarding touch-ups should address the situations in which reintervention should be considered. Generally, the main reasons for touch-ups are unsightly scars and noticeable asymmetry, which can be regarded as suboptimal results.
Scar revision
All plastic surgeons regard scarring with great concern; most scars are camouflaged by their placement in natural skin creases and refined closure techniques. However, because each patient’s wounds heal differently, surgery may leave perceptible scars. Thankfully there are non-surgical options to treat hypertrophic or inflamed scars, such as silicone gels and anti-scarring creams. Before considering scar revision, it is important to let the scar mature, about 6 to 8 months. Then, revision is a good option to improve the appearance of the scar.
Postoperative asymmetry
Eyelid plastic surgery contours adjacent tissue surrounding the eyes. Some patients might perceive a difference in their eyes’ shape postoperatively, mostly because of an unrecognized difference before the surgical intervention. It is necessary to point out that everyone has some level of asymmetry in the shape of their eyes, and it behooves the operating surgeon to point out these differences before surgery.
Often, referring patients to their preoperative photographs will clear up any concerns. However, if the postoperative asymmetry is more pronounced after 3 to 6 months of the surgical procedure, I consider a touch-up necessary.
My policy regarding touch-ups
To successfully correct a postoperative concern, both patient and surgeon must agree on its nature. I do not charge surgeon fees for a touch-up as long as we have given the tissues enough time to heal, about 3 to 6 months for most procedures, and I believe that the procedure will significantly improve the patient’s result. This gives my patients peace of mind and creates an environment of trust during recovery. Patients are asked to assume anesthesia fees, if necessary, and facility costs.
As surgeons grow and mature, we become better equipped to respond to the incredible honor and burden of responsibility when operating on our patients. This means doing what is best and safest for them. We set realistic expectations of what the surgery can and cannot achieve and strive for perfect results. Nevertheless, we have learned to accept the fact that human tissues heal differently, and a touch-up is a part of what we do. In my practice, I assure my patients of my commitment to see them through their surgical journey until they are satisfied with the outcome.
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