Scars after eyelid surgery: how they heal, what helps, and when to ask your surgeon

Eyelid scars usually heal well, but they take months, not weeks, to settle. A review of blepharoplasty complications states that eyelid skin heals better than almost any other skin on the body. Pinkness, a firm line and some lumpiness along it are expected in the first months, and the NHS says most scars fade over time, which can take up to 2 years or more. A scar that turns thick and red, darkens, or pulls the lid out of position is the kind to show your surgeon early.

Do scars after eyelid surgery heal well?

Usually, yes. The review of blepharoplasty complications by Oestreicher and Mehta says eyelid skin heals better than almost any other skin on the body, but adds that the wound still has to be placed symmetrically and closed carefully to avoid asymmetry and scarring. The NHS says the cut for lower blepharoplasty is made just below the lashes or inside the lower lid. A scar is how the body closes any wound, so the real question is how fine, flat and pale it ends up.

The NHS also lists noticeable scarring among the occasional results of eyelid surgery, so the honest answer is that most heal well and some do not. The wider list of recognised problems is in my article on complications after eyelid surgery, and this piece takes only the scar from it.

How long does an eyelid scar take to fade, and what is normal on the way?

Expect redness for several weeks and a scar that feels tight for a few months, with full fading taking longer. The NHS says bruising and redness after eyelid surgery take several weeks to fade, and that scars can feel tight for months. For scars in general it says most fade over time without treatment, which can take up to 2 years or more. The week-by-week picture of the early period is in the upper blepharoplasty recovery guide.

What is normal in that time: a pink or slightly darker line, mild itching, a ridge you can feel under the fingertip, and a firm crease where the wound has knitted. The NHS notes a fine-line scar can be slightly raised to start, but usually flattens and fades over time without treatment. Oestreicher and Mehta describe an incision line that is a little thick and red at 4 weeks as a stage where time and massage are useful, not a reason for alarm. Because fading can take up to 2 years, a scar at six weeks is not the final scar.

What helps an eyelid scar heal, and what does the evidence say?

The measures with the most support are protecting the new scar from the sun, silicone gel, and, once the wound has fully healed and the surgeon agrees, gentle massage. Leaving the wound alone, with no picking at crusts, is the basic rule.

Sun protection. The NHS advises keeping a scar covered in the sun for at least 1 year and using sunscreen of SPF 30 or higher on it. An international group of 24 experts also lists ultraviolet protection among the measures for early scar tissue. The blepharoplasty review lists haematoma (a collection of blood) and excess sun exposure as causes of postoperative darkening of the skin. On the eyelid, that usually means a hat and sunglasses, with sunscreen only once the surgeon confirms the wound has closed.

Silicone gel. The Cochrane review of silicone gel sheeting pooled 20 trials involving 873 people. In people prone to scarring it reduced the incidence of hypertrophic (raised, thick) scarring, with a risk ratio of 0.46, but the authors call the evidence weak and the trials highly susceptible to bias. The 2014 practical guidelines treat silicone sheeting or gel as the first-line option, and a panel for Asian patients found strong evidence for silicone products, considered them first-line because they are easy to use, and noted that gels have shown efficacy. For the eyelid itself, a retrospective review of 272 upper blepharoplasty eyelids found that 22.9% of those treated with a silicone-based cream for 3 months later needed a scar injection, against 43.9% of those untreated. It was one surgeon's records, not a trial, so it points in a direction without settling the matter.

Massage. The NHS says to massage a scar with a water-based cream a few times a day, but only when the wound is fully healed. The evidence is thinner than the habit: a systematic review of scar massage covered burns, found preliminary benefit, and described the research as poor quality. It does not test eyelid wounds. Because an eyelid wound is small and may not be fully closed at the edges, the surgeon decides when and how, and that instruction takes priority over general advice.

Do not pick, scrub or peel the line, and do not apply a cream to a wound that has not closed. The NHS asks you to contact the clinic promptly for severe pain or unexpected symptoms after eyelid surgery.

Do scars heal differently in darker or Asian skin?

They can. Asian skin has a greater tendency to hypertrophic scarring and to scar colour change, so the recommendation is to start prevention early. A 2013 expert panel on Asian patients states that after surgery, scar prevention should be started in all Asian patients because of the high risk of poor scars, and that Asian skin tends towards hyperpigmentation and scar formation. A 2025 paper on epicanthoplasty makes the same point, that Asian patients have greater tendencies for hypertrophic scarring and for scars that turn lighter or darker.

Post-inflammatory hyperpigmentation, the darkening that follows irritation or inflammation of the skin, is the colour change described in that research, and sun protection is part of the advice above. A keloid is different: a raised, hard scar that grows beyond the original wound. The NHS describes it this way, and Oestreicher and Mehta say true keloids of the eyelid skin are rare. A hypertrophic scar is also raised and firm, but the NHS says it does not grow beyond the original wound and usually fades and flattens over time. The same review advises against laser skin incisions in Asian and Black patients because of a higher risk of scar hypertrophy and colour change.

Knowing your own history matters. Whether earlier scars thickened or darkened is a fact a surgeon wants before the operation. Double eyelid surgery has its own scar questions, covered in the guide to double eyelid surgery for Asian eyes.

What if a scar pulls the eyelid out of position?

A scar that shortens or tightens can drag the lid, and this needs assessment rather than waiting. In the lower lid, the review says retraction (the lid sitting too low, with white showing below the iris) can result from skin shortage, scarring of the middle layer around the orbital septum, or tightening of the inner layer. I explain the pattern in the article on eyelid retraction after surgery.

The options in the literature are graded. For early tightening in the lower lid, the review describes patient-directed upward massage, and says an injection of a non-depot steroid (one that is not left as a long-acting store in the tissue) can occasionally spare a patient a bigger operation. For medial canthal webbing in the upper lid, a skin bridge across the inner corner, it says early recognition and massage resolve most cases, and persistent ones are treated with a V-Y plasty, a small skin rearrangement.

Inner-corner surgery has the same concern. A 2025 review of epicanthoplasty says scar formation is a principal complaint and webbing a recurrence risk, and a series of 116 patients describes silicone gel creams from 2 weeks and, for early thickening, an injection mixing a steroid with fluorouracil, an anti-scarring drug. One patient (0.8%) needed revision for a residual web. Those numbers belong to one technique in one group of patients, so I use them to show what exists, not what to expect. The details are in the epicanthoplasty article.

Steroid injection, massage and revision are all options a surgeon assesses case by case. None is automatic, and a scar can be left alone if it is not bothering you.

When should you contact your surgeon about a scar?

Contact your surgeon the same day if the wound opens, the redness spreads, or the scar becomes swollen, warm, painful or leaks pus, and promptly if the lid begins to pull or the eye does not close. For any scar, the NHS gives swelling, pain, warmth to the touch and pus as reasons to seek urgent advice.

Also ask, without waiting for the next routine visit, if a scar turns thick and red, keeps darkening, itches intensely, or the lid starts to look pulled up, pulled down or webbed at the inner corner. An eye that will not close fully dries out, and the corneal surface can be damaged, which is why I cover it in the article on lids that do not close. The sources that describe the gentler options all speak of catching thickening or tightening early.

Dr Catherine Chow begins consulting at Eagle Eye Centre Malaysia, Petaling Jaya, from early 2027. Until then, a scar that worries you after eyelid surgery should be looked at by the surgeon who operated, or by another eye surgeon. For the wider question of what to weigh before an operation, see the section on deciding on eyelid surgery, and my hub article on why eyes look tired.