What not to do after a blepharoplasty
After a blepharoplasty, what shapes the result most is not what you do but what you avoid during the first two or three weeks: no physical exertion and no bending with the head below the heart, no rubbing or pressing on the eyelids, no sleeping flat or face down, no contact lenses or make-up over the incisions until they have closed, no anti-inflammatories or supplements that increase bleeding without checking first, and no sun exposure on the scars without protection. Each of these instructions has a specific reason behind it — almost always the risk of bleeding or of a worse scar — and in my experience explaining those reasons does far more for compliance than handing over a closed list. This is what I tell my patients, and why.
Why should exertion and bending over be avoided?
The eyelid is very thin and very well vascularised tissue, and in the first days the vessels sealed during surgery are still fragile. Any manoeuvre that abruptly raises venous pressure in the head — lifting weight, bending with the head below the heart, straining on the toilet, repeated coughing, or training hard — can reopen one of them. In most cases that simply means more bruising and more swelling, and therefore a slower recovery. But there is an uncommon complication that is the real reason I insist: a retrobulbar haematoma, bleeding behind the eyeball that can compromise the optic nerve and that constitutes a genuine emergency. It is infrequent, but it is partly avoidable, which is why I do not negotiate this restriction. In practice: no gym or sport for around two to three weeks, returning progressively and later still for weights or contact sports; no carrying shopping bags or picking up children; bend at the knees rather than the waist; and pay attention to hydration and fibre in those first days precisely so that straining in the bathroom is not necessary. Sleeping with the head of the bed raised and avoiding lying face down follows the same logic: helping drainage and keeping the eyelids off the pillow.
Can I touch my eyes, wear contact lenses or use make-up?
Rubbing is the hardest impulse to control, because eyelids itch as they heal. It is worth resisting: traction on a recent suture line can widen the scar and, in the lower lid, encourage retraction of the lid margin — which is precisely the most awkward sequela to correct afterwards. Nor should crusts be picked off; they come away on their own. Contact lenses are resumed once the swelling has settled and the surgeon confirms it — usually around two weeks — not so much because of the lens itself as because of the manoeuvre of inserting it, which involves pulling on the eyelid. Make-up is similar: the problem is less applying it than removing it, which requires rubbing, so I do not allow it over the incisions until they are completely closed. And there is a common mistake in the opposite direction: many patients notice transient dry eye, or do not fully close the eye while asleep during the first days, and stop using artificial tears or lubricating ointment as soon as the discomfort improves. That is not advisable: lubrication is continued for as long as it was prescribed, even if the eye no longer feels dry, because it protects the cornea precisely while eyelid closure is not yet complete.
What medication, supplements and habits should be avoided?
Anti-inflammatories such as ibuprofen and acetylsalicylic acid increase the risk of bleeding, and it is common for a patient to take them on their own initiative for the swelling without realising they are exactly what should be avoided; unless indicated otherwise, paracetamol is usually the analgesic of choice in that period. There is also a group of supplements that almost nobody mentions spontaneously, because they are not thought of as medication, and that can indeed promote bleeding: fish-oil omega-3, ginkgo biloba, garlic in high doses, vitamin E, or ginseng. I ask about them before surgery for this reason, and they should not be reintroduced without discussing it. Anticoagulants or antiplatelet drugs prescribed by another doctor are a separate matter: they are never stopped or restarted unilaterally, but in coordination between the surgeon and whoever prescribed them. As for habits, tobacco worsens tissue oxygenation and healing, and alcohol causes vasodilation and fluid retention, increasing the swelling of the first days. I also advise against sauna, steam rooms, very hot water, swimming pools and the sea in the first weeks: heat increases swelling, and uncontrolled water carries a risk of infection while the incisions are not yet closed.
What should not be done with the scars, or with the sun?
The upper eyelid incision hides in the natural crease and usually ends up hard to see; the lower one, when done externally, sits just below the lashes. But during the first weeks both can be pink and slightly thickened, and that is precisely the window in which mistakes show. The main one is sun: ultraviolet radiation on an immature scar can leave hyperpigmentation that is then hard to reverse, and eyelid skin is among the thinnest on the body. Wide sunglasses and, once the wound has epithelialised and with the surgeon's approval, sun protection suitable for that area. Nor is it wise to jump ahead with massage, silicone or "scar creams" before being told to: on a wound that has not yet closed they are counterproductive, and the moment to start is set by the follow-up visit, not by the calendar. And there is something that is not a restriction but spares a great deal of unnecessary anxiety: do not judge the result in the first weeks. It is common for one eye to settle before the other and for the asymmetry to be striking for a few days; that does not predict the outcome, because the definitive shape takes months to settle.
Which warning signs should not be left to settle on their own?
The other side of "what not to do" is "what not to ignore". What is expected after a blepharoplasty is swelling, bruising that changes colour, a gritty sensation, watering and slightly blurred vision from the ointment; all of that improves progressively and needs nothing beyond the scheduled reviews. There are, however, three situations that should not wait for the next appointment. The first is intense, sudden pain in one eye, particularly with rapidly increasing swelling or a sense of pressure in the orbit, protrusion of the eyeball, or any loss or reduction of vision: this is how a retrobulbar haematoma presents, and it requires immediate attention, not observation at home. The second is infection: spreading redness, local warmth, purulent discharge or fever. The third is being unable to close the eye with associated corneal pain, which needs assessment to protect the cornea. In consultation I always put it the same way: I would rather see a patient who came in over something that turned out to be nothing than one who spent the night waiting to see whether it would pass.
A good part of what can go wrong with a blepharoplasty does not depend on what happens in the operating theatre, but on what happens in the first two weeks. None of these restrictions is particularly demanding, but every one of them has a reason, and I prefer to go through them one by one before operating: once recovery is under way, they are remembered considerably less well.
Related specialty: Blepharoplasty
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About the author
Dr. Pablo Vaquero is an attending Oral and Maxillofacial Surgeon at Vall d’Hebron University Hospital (Barcelona) and a surgeon at the Instituto Maxilofacial at Centro Médico Teknon. Trained in Hong Kong, Buenos Aires and Charité Berlin, he is Spain’s National Trainee Representative to the EACMFS and the author of scientific publications and the Lifting Surgery chapter of the SECOM CyC reference manual.