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.

Cold application is good for the first 48 hours to minimize bruising and swelling. Cold will cause contstriction of the vessels to achieve this. After 48 _ 72 hours warm compress will increase the circulation to the area and may speed up the healing process but is not as effective as the cold application.

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.

This is a great question! You will likely find a wide range of answers to this question and the biggest reason is there is not a significant amount of evidence that would dictate an exact recommendation for ice vs warm packs. In general, ice is best for the first several days to a week after surgery as this will help with inflammation. The reason that warm compresses are not recommended initially is that this will dilate the blood vessels which can bring more fluid into the area. These may become helpful later in the recovery process when the acute inflammatory phase has passed and you want to open the lymphatic channels to allow fluid to leave the operative area. At the end of the day, alot of the recommendations are surgeon preference more than exact science!
Hope this helps!Kyle Kimura, MD Facial Plastic and Reconstructive Surgery

Good question - no evidence based (factual) answers.  It is thought that cold compresses constrict (squeeze closed) blood vessels immediately after surgery to reduce swelling.  After a few days using warm compresses to do the opposite (open vessels to suck in fluid) may help.  It is best o do what your surgeon suggests based on their experience.  Certainly no harm comes from this.  Is it a benefit - maybe??

In my practice, I have found it useful to use cold compresses in the first 48-72 hours to lessen swelling and the formation of bruises. Swelling tends to increase during the first few days, reaches a peak, and then diminishes over many weeks. At the same time, bleeding under the skin during the first few days leads to bruising, which leads to more swelling. The idea behind the cold compresses is to reduce the rate of initial swelling and bleeding under the skin, thus reaching a lower peak from which to recover.
After the peak of swelling has been reached, cold compresses do not seem to work as well. Also, under the skin bleeding has diminished and bruising has declared itself. Now the body has to rid itself of swelling and bruises and I believe this is directly related to rate of metabolism. With heat, one may locally increase the rate of the the processes involved in metabolizing and transporting away excess fluid and bruises.
I fully admit that I cannot reference any scientific studies to support these ideas, but may patients have anecdotally found this to be a useful regimen. 

There are many tricks to post operative care after delicate surgeries. In the first 48 hrs I ask the patients to use cold compresses. This decreases the swelling. After the 48hr mark I have them alternate cold and warm compress every 20 minutes while awake. The role of the warm compress is to increase the blood supply to the area to allow the blood and vessels to dilate which will help absorb the swelling and bruises.  Decreasing salt content ( sodium content less than 1,000mg / day) can really help with swelling.Hope this helps.Best of luck,DrC

Thank you for your question.  I will always advise my patients to use cotton pads soaked in Witchazel (buy from chemist), which has been left in the fridge.  Use this as cold compresses as often as you can, this will sooth and reduce swelling.  Do use an eye ointment such as: chloramphenicol, this needs to be applied just before you go to bed, this is a mild antibiotic as well as providing your eyes with lubrication at night.  The ointment can cause some blurriness which is only temporary and resolves by the morning.All The Best 

I also recommend cold compresses for the first few days.  Warm compresses later may help break up bruising.  I don't know if it works, but I suggest you follow the surgeon's instructions, but also be patient.

Use cold compresses (crushed ice in a glove or bag or frozen peas/corn) over your eyes for
20-30 minutes six times per day for the first 48 hours. This will minimize the swelling and
bruising.

After blepharoplasty, most surgeons recommend cold compresses for 2-3 days. It is not clear if there are any benefits of cold or hot compresses after that time. Arnica might be helpful, but this too is not certain. It would probably be wise to start moving around a bit more 3-4 days after the operation.