Full-incision sagging-skin removal Double eyelids, does swelling subside in 2 weeks? Asymmetry and scarring that tend to persist

In full-incision sagging-skin removal Double eyelids (surgery that removes skin to create a Double eyelid line), mild swelling and bruising settled within 2 weeks, according to a report compiled from 4,129 cases[1]. The problem most likely to persist after surgery is asymmetry rather than swelling; in the same report, 230 people showed asymmetry in the line, and 86 people showed thinning of part of the line[1]. Numbness of eyelid skin sensation occurs in many people and typically returns within 2–6 months, according to guidelines[2].

When does swelling and bruising subside?

In the report of 4,129 cases, mild short-term swelling and bruising occurred in 327 people and settled within 2 weeks[1]. There were no severe hematomas or hypertrophic scars, and infection occurred in only 1 lactating person[1].

A report of a different surgical technique designed based on anatomical findings in 1,272 people also noted short recovery, long-lasting results, and few failures[3]. The duration of swelling varies depending on the surgical technique and the amount of tissue removed[1], so you should confirm what will be removed in your surgery.

In full-incision, what is removed?

Traditional full-incision removes upper eyelid skin, and when necessary, also the orbicularis oculi muscle, orbital fat, and fat below the brow (ROOF)[1]. The method of suturing skin directly to the tarsal plate (the fibrous tissue core of the eyelid) has been pointed out to tend to result in a deep line with little movement and a noticeable scar[1].

Textbooks organize the indications for full-incision as sagging skin, thick eyelids, abundant orbital fat, and moderate or severe ptosis[4]. The mechanism of line formation is explained as adhesion forming between the aponeurosis that lifts the eyelid and the skin, due to muscle division[5].

How long do scars and numbness last?

The rate at which scarring becomes an issue is reported in the literature as 1.2–5.6%[1]. In the report of 4,129 cases, depressed scars were seen in 5 people, and there were no hypertrophic scars[1].

Numbness of eyelid skin sensation occurs in many people who have incisions along the Double eyelid line and typically returns partially or completely within 2–6 months, although in rare cases it may not return, according to guidelines[2].

The problem most likely to persist is asymmetry

What tends to remain after swelling subsides is asymmetry. In the report of 4,129 cases, line asymmetry was seen in 230 people, and thinning or narrowing of part of the line was seen in 86 people[1]. Analysis of 138 complaints over 7 years showed that "asymmetry" was most common, both in primary and revision cases, and most often involved line height difference[6].

Asymmetry and line loss are also related to patient-side factors. In an analysis of 202 patients who underwent revision surgery, age over 30, thick eyelid skin, epicanthic fold, weak levator muscle, and short distance between eyes and brows were associated with asymmetry, line loss, shallow line, and low line[7].

Line height design also plays a role. In measurements of 1,272 cases, the average tarsal plate height was 8.96 mm, and the height where the septum and aponeurosis converge was 10.95 mm on average—higher than previously thought—which is considered a contributing factor to unnatural high lines in classical techniques[3][8].

What signs mean you should see a doctor?

The typical course is mild swelling and bruising subsiding within 2 weeks[1]. If swelling or pain intensify, bleeding continues, the scar becomes red and raised, or one side suddenly swells beyond that time frame, contact the medical facility where you had surgery without waiting for your next appointment[1].

Numbness typically returns within 2–6 months[2], so if numbness persists beyond 6 months or if asymmetry remains clearly present, these are matters to discuss at a follow-up examination[6][2]. Guidelines recommend that complications such as asymmetry and difficulty closing be evaluated at 1–3 months post-operatively and again at 9 months to 1 year[2].

What to confirm at your follow-up examination

What you want to confirm is how much skin will be removed, whether muscle or fat will also be taken, at what height the line will be set, and in which layer it will be fixed[1][3]. The appearance of the scar changes depending on the fixation method[1], and line height is determined by measurement of tarsal plate height[3].

If you meet criteria such as age over 30, thick eyelids, epicanthic fold, or weak levator muscle, you need to plan with the understanding that asymmetry and line loss are more likely to occur[7]. Which criteria you meet should be confirmed with your doctor after having your eyelids examined during consultation.