Cold vs. Warm Compresses After Blepharoplasty?

Dear Rookshire

First the use of cold and warm compresses have much more to do with surgical tradition than evidence base medicine.  We as surgeons recommend these physical treatments not because we have a large body of scientific evidence demonstrating their effectiveness but rather, we recommend them because that is the way we were taught.  You can see that there is a general consensus that early on, cool compresses are used then later warm compresses.  

Do cool or cold compresses reducing swelling?  It is a good question.  Certainly many patients find the cold comforting.  This may be reason enough to recommend this treatment.  I personally believe that involving the individual in their own care is a helpful part of the healing process.  The fact is there are no great studies that answer these questions.  We do not know how effective cold compresses are or if they are effective at all.  There are reports of individuals over doing cold compresses and causing frost bite to the skin.  There is also a study of cold urticaria following eyelid surgery.  This is swelling and inflammation triggered by the cold compress.  

The same uncertainty exists for warm compressing after surgery.  

What to do?  Don't ask the pharmacist.  Please listen to your surgeon and follow their advice.  If you end up doing less compressing than recommended, remember the recommendations are intended to make you more comfortable.  If you are too cold and choose to to do less compressing, it is not likely to have much bearing on your ultimate outcome.

The philosophy of cold compresses is to cause blood vessels to contract and limit the bleeding, bruising and the capillary ooze after surgery.  But after 5 days or so, you are not swelling.  You are resolving swelling.  You need those same vessels to dilate and carry more blood to the area to help resolve swelling in the area.

Our goal is to reduce swelling and bruising after surgery.  Therefore I advise patients to use cold compresses (a bag of frozen peas works well!) for 2 to 3 days after surgery.

Of course it's also a good idea to avoid anything that brings the blood rushing to your face: bending, lifting and straining.

After the first 2 or 3 days you can do whatever feels good: warm, cold or nothing at all.

Good luck!