Flap complications at a glance
| Problem | When | Modern frequency | Fix |
|---|---|---|---|
| Striae (wrinkles) | Day 1 to week 1 | Under 1% | Lift, stretch, reposition |
| Dislocation / slipped flap | Day 1, or after trauma any time | Well under 1% | Lift and reposition, sometimes sutures |
| Epithelial ingrowth | Weeks to months | 1-3% primary, higher after enhancement | Lift, scrape, sometimes glue or sutures |
| Buttonhole / incomplete flap | During surgery | Rare with femtosecond | Abort, heal, retreat with PRK later |
| Free flap | During surgery | Very rare with femtosecond | Reposition; usually still heals well |
Striae
Fine folds in the flap, usually from slight misalignment at the end of surgery or from rubbing the eye in the first hours. Microstriae are common and harmless; visually significant striae produce ghosting and are treated by lifting the flap, hydrating and stretching it, and repositioning. Early treatment gives the best results, which is why the day-one visit exists and why you sleep with shields the first nights.
Dislocation
The flap can shift if the eye is rubbed hard or struck in the first days. Late dislocations years later from significant trauma have been reported, because the flap never fully regains original strength. It is repositioned surgically. This is the reason surgeons steer boxers and MMA athletes to PRK or SMILE; see flapless vs flap safety.
Epithelial ingrowth
Surface cells migrate under the flap edge and form a nest. Small peripheral ingrowth is watched. Ingrowth that advances toward the center, or lifts the flap edge, is treated by lifting the flap and scraping the cells away; recurrence is sometimes managed with fibrin glue or a temporary suture. Risk is higher after a flap lift for enhancement, which is one reason many Colombian surgeons prefer PRK over the flap for late enhancements.
Intraoperative flap problems
With femtosecond lasers (all-laser LASIK), buttonholes and free flaps have become rare. When they happen the surgeon usually stops, lets the eye heal for a few months, and performs PRK. Ask whether the clinic uses a femtosecond laser for the flap; blade microkeratomes are still in use in some lower-cost settings and carry higher flap-complication rates. Read bladeless LASIK technology.
Traveller's protocol for the first week
- Shields taped over both eyes when sleeping for at least five nights
- No eye rubbing, ever; if something is in your eye, rinse with preservative-free tears
- No swimming, saunas, or dusty environments for two weeks
- No contact sports for a month; longer for anything involving blows to the head
- Keep sunglasses on outdoors, partly for UV and partly as a physical barrier
Signs to act on
Sudden blur, a sensation of something moving on the eye, a visible edge or fold when you look in the mirror, or pain in the first week: contact your surgeon the same day. A dislocated flap repositioned within hours generally heals without lasting effect; one left for days can develop folds and ingrowth that are harder to treat.
Frequently asked questions
Can a LASIK flap move years later?
Only with significant direct trauma. Everyday life does not dislodge a healed flap, but the interface never regains full original strength.
Does SMILE avoid all of these?
SMILE has no flap, so striae, dislocation and ingrowth are essentially eliminated. It has its own rare issues, such as difficult lenticule extraction.
Is epithelial ingrowth dangerous?
Peripheral ingrowth is usually harmless and monitored. Progressive ingrowth needs treatment to prevent flap melt and astigmatism.
Want femtosecond-only clinics?
Tell us where you want to be treated. We will only suggest Colombian clinics using all-laser flap creation.
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