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Post-Operative Instructions | Eyelid Surgery

Post-operative instructions may vary for each individual patient. Please ask your doctor for your own personalized set of post-operative instructions. Do not hesitate to contact our office with any questions. We wish you a speedy recovery!

Activities

Apply gentle ice packs to the surgical area for 30 minutes out of every hour for the first 72 hours while you are awake.

  • Ice helps with pain, decreases swelling, and reduces bruising. Ice does not help as much after 72 hours. Do not put ice cubes directly on your skin. Put green peas in a ziplock bag. Moisten gauze with distilled water and put the wet gauze between your eyelids and the bag of peas.

Sleep on your back with your head elevated above your heart for 1 week after surgery.

  • Keeping your head elevated will reduce swelling after surgery.
  • The easiest way to do this is simply with an extra pillow. It is common for wounds to ooze the first few days, so you may want to cover your pillow with an old towel. You may also choose to sleep in a recliner chair if you have one. This will help prevent you from rolling on to your side while sleeping.
  • If you cannot do this because of back or breathing problems, that is ok, but you will notice more swelling in the morning.
  • If your head rolls to the side when you sleep, you will notice that the side facing downward will have more swelling due to gravity.

Do not bend with your head below your heart, lift things heavier than a gallon of milk, or do anything strenuous for 1 week.

  • A sudden increase in blood pressure is the #1 reason to have substantial bleeding after surgery. While rare, bleeding behind the eye after surgery can cause permanent vision loss. Avoiding these activities will help prevent this complication.
  • Wear slip-on shoes (don’t bend over to pull up socks or tie shoes). Have someone help you with the dishes and laundry if you have to bend over to do them. If you have a dog, avoid bending to clean up after him or her.
  • You may resume your regular activities including your regular exercise routine on Day 8 after surgery.

Wear the eye shield(s) every night at bedtime for a full two weeks after surgery.

  • The surgical wounds are fragile for 2 weeks after surgery. Accidentally rubbing them during sleep is the most common way a wound will accidentally open after surgery (see the “Common Questions” section for what to do if you think your wound has opened).

Avoid getting shower water or tap water on your wounds for 7 days.

  • This is important for preventing infection. There have been increasing reports of surgical wound infections from tap water.
  • You may wash your hair with distilled water (available at drugstores and grocery stores). You may also wash your hair in the shower if you can tip your head back and let the water run down the back of your head rather than down your face. Some women choose to have their hair washed at a salon or use Dry Shampoo.
  • After 1 week, you can shower normally, but do not rub your eyelids, forehead, or cheek because the wounds are still healing. Gently pat dry the area. Rubbing the wounds after showering is the second most common way a wound will accidentally open after surgery.

Avoid hot tubs, saunas, ocean/lake water, and swimming pools for 2 weeks.

  • This is important to prevent infection. Soaking the wounds also weakens them in the first two weeks.

Do not smoke for at least 14 days after surgery.

  • Smoking decreases blood flow to the wounds and delays healing. If your surgery included Mohs reconstruction, smoking can cause the reconstruction to completely fail.
  • Of course, quitting smoking is the best for your health! There’s no time like now. Ask your doctor for help quitting if you’re ready.

No driving for at least 48 hours after surgery. No driving if you are in pain, if your vision is blurry, or if you are taking narcotic pain medication.

Diet

You may eat immediately after surgery. Start with a gentle diet.

  • Lingering effects of your anesthesia can lead to an upset stomach. Start with clear liquids. Avoid advancing to a regular diet until you are certain you are feeling okay. Plain crackers or toast with a non-caffeinated carbonated beverage like Sprite is often a good place to start. Notify us if you start having severe nausea or vomiting, which can cause re-bleeding with increased swelling and bruising.

 Avoid drinking alcohol for 1 week after surgery.

  • Alcohol will delay healing, increase swelling, increase bruising, and increase the risk of bleeding after surgery.

Avoid salty and processed foods for 2 weeks after surgery.

  • Salt increases swelling, which makes healing take longer.

Medications

Resume all oral medications after surgery unless instructed otherwise.

Resume your physician prescribed blood thinners as directed after surgery.

  • If you normally take aspirin, fish oil, flax oil, omega-3s, or vitamin E for your general health (not prescribed by a physician), wait 1 week before restarting to prevent bleeding and worsening bruising.

Use the antibiotic ointment on your stitches or wounds 4 times per day for 7 days.

  • This keeps the wounds moist to promote healing and prevents infection. The ointment will not hurt your eye if it gets in the eye (it is formulated for use in the eye), but it will make the vision blurry because it is greasy.
  • Apply the ointment with a clean fingertip or a Q-tip.
  • Do not apply the ointment right before driving as it will blur the vision if it gets in your eye.
  • After 7 days, you may apply a small amount of Vaseline on your incisions at bedtime for 1 month.

If you have pain, try taking Extra Strength Tylenol (500mg) as instructed on the bottle.

  • It is normal to have some pain after surgery. The pain should improve on a daily basis.
  • Do not take Tylenol if you have liver disease. Do not take Tylenol while drinking alcohol.
  • If your pain does not improve to a manageable level, please contact our office for assistance.

Do not take NSAID pain relievers for 7 days after surgery as they can increase the risk of bleeding.

  • NSAID medications include ibuprofen, Advil, naproxen, Aleve.

 Take the anti-nausea medication as needed. Follow the instructions on the bottle.

  • Follow the diet advice above if you have nausea. Notify us if you start having severe nausea or vomiting, which can cause re-bleeding with increased swelling and bruising.

You may wish to use a gentle over the counter stool softener (such as Colace) to prevent constipation.

  • It is common to have constipation after surgery. It is also common for narcotic pain medications to cause constipation.

PLEASE CALL YOUR DOCTOR’S OFFICE IF YOU EXPERIENCE:

  • A decrease in vision or double vision.
  • Uncontrolled bleeding that will not stop with gentle pressure.
  • Pain or nausea that is not controlled with medication.
  • Signs of infection including redness, pus-like discharge, warmth, and pain.
  • Fever greater than 100F.
  • Any other concerns.

Common Post Surgery Concerns

  1. A small amount of bloody oozing or blood-stained tears are normal in the first few days after surgery.
  2. It is alright to use your operated eye for reading, watching television, and using your computer. This will not hurt your eyes.
  3. Eye irritation, scratchiness, or the sensation of an eyelash in the eye is common in the first few days after surgery. This will improve with time. Over the counter artificial tears can help with this. If the eyes are painful, please contact your doctor immediately.
  4. Mild to moderate itching is common during the first week or two and is a normal sign of healing. This type of itching often improves with a cool compress. Severe itching accompanied by worsening of swelling and redness may be an allergic reaction to the ointment or eye drops. Allergic reactions to ointments and eye drops usually start 3-5 days after surgery. If you have severe itching with redness and swelling, please contact your doctor. There are things we can do to help you feel better.
  5. Numbness around the scar is common but typically resolves. Even the most delicate surgery creates controlled trauma to the skin including injury to the small nerves that provide sensation to the skin. This usually improves over the course of 6 weeks to 6 months.

Bruising and Swelling Concerns

  • Bruising and swelling is usually at its worst the day after surgery and should gradually get better each day.
  • Swelling follows gravity. It is usually worse in the morning after having your head reclined at night. Swelling gradually improves throughout the day with ice and sitting upright.
  • For most patients, swelling is about 80% resolved at 4 weeks after surgery, 90% resolved at 8 weeks, and can take up to 6 months for all the swelling to resolve. This is because it takes time for the body’s drainage system (lymphatics) to heal after surgery. You will notice more swelling after sleeping with your head flat, after eating salty food, or drinking alcohol.
  • It is common to still have some bruising at 1 week after surgery. Bruising should be mostly gone after 2 weeks.
  • After upper eyelid surgery, it is common to have bruising and swelling of the lower eyelids down to the cheeks and even sometimes down to the jaw (this is from gravity)

Information About Your Stitches

  • The incision lines are fragile for 2 weeks, treat them carefully and do not rub them.
  • Stitches that are clear or skin colored will dissolve on their own in 1-2 weeks and do not need to be removed.
  • Stitches that are purple, blue or white will be removed by your doctor in the office.

Information About Scars

  • Eyelid scars typically heal very smoothly compared to scars elsewhere on the body. It is very rare for an eyelid to develop a keloid or hypertrophic scar (even in patients who have had keloids elsewhere on their body).
  • Scars are most pronounced at 1 month after surgery. The scar may be elevated and red or hyperpigmented at this time. This is normal.
  • Your doctor will evaluate your scar at each follow-up visit. If needed, a small injection of steroid directly into the scar can help improve the appearance.
  • There are many “scar creams” that promise to improve the appearance of scars. I have not seen any good scientific evidence that they work well on the eyelid area, so I do not routinely recommend them. Keeping the incisions moist, initially with your prescribed antibiotic ointment and then with a small amount of Vaseline at bedtime for 1 month after surgery, can help keep them supple and promote healing.
  • To prevent hyperpigmentation of your scar, it is important to protect it from the sun with sunscreen every day (SPF 30+) and sunglasses when you are outside. You may apply sunscreen to your incision line starting day 14 after surgery. I recommend mineral based formulations (containing zinc oxide and titanium dioxide) as they are less irritating than chemical sunscreens.
  • Please remember that healing wounds take many months to mature. With each passing month, you will notice improvements in scar appearance and texture. It may take up to a year for your scar to become as soft and unnoticeable as desired.