Cold vs. Warm Compresses After Blepharoplasty?

I have been advised by my surgeon that after a blepharoplasty to apply cold compresses. I understand this purpose for the first few days but am confused on why he is now recommending using warm compresses. My purpose is to get rid of the swelling and I've been told by a pharmacist cold does this better. I am not concerned about bruising, but can a surgeon please explain the advantage of switching to warm compresses for getting rid of swelling? If I prefer can I still use cold compresses?

Doctor Answers 34

Not a well studied subject.

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.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

cold versus warm compresses after blepharoplasty

While cool compresses can feel good for the patient, we do not recommend cold  compresses due to the potential of frostbite due to the skin being numb after the procedure. There is no scientific evidence that cold or warm compresses in the first week or 2 will speed the healing process. For many examples of eyelid surgery, please see link below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Heat or cold?

Hi, I too recommend cool ice compresses for the first 1-2 days and then the patients can stop, continue, or switch to warm if they like.  I like warm wet wash cloths because it cleans up some of the matter and "scabby" look to the incisions as well as the redundant, caked on antibiotic ointment.  However, I tell my patients that after the 1st day or 2 of ice, I want them to do what is most soothing.  Ultimately, none of it affects the end result and the healing process is really a tincture of time if all has gone well with your procedure.

Good luck!

Jasmine Mohadjer, M.D.

Oculoplastic Surgeon,

Largo, FL

Jasmine Mohadjer, MD
Tampa Oculoplastic Surgeon
5.0 out of 5 stars 2 reviews

Hot or Cold Compresses

Cold and hot compresses are both useful after eye surgery, but for very different reasons.

Cold gel packs are used to:

  • Reduce/limit swelling
  • Relieve discomfort

Warm compresses can be used to:

  • Reduce bruising
  • Soften early scar tissue

For the first week, I recommend Cold gel packs.  After the first week, moist Warm compresses can be used to speed the resolution of bruising.  Some patients have used warmed Black Tea bags, as this also has an antioxidant effect.

Andrew Winkler, MD
Lone Tree Facial Plastic Surgeon
4.5 out of 5 stars 9 reviews

Compresses After Eyelid Surgery- Cold vs. Warm

Swelling and bruising are normal after surgery, but can be minimized by good surgical technique and control of pain and blood pressure. I do not like cold or hot compresses, as they can burn the delicate skin, but instead have my patients use a cool soak (washcloth soaked in a bowl of ice cubes and water) and warm soak, washcloth placed under warm faucet.

Cool soaks reduce early swelling and pain by constricting blood vessels and reducing blood and fluid leakage. They also help to reduce early pain by numbing the nerves.

After the first few days, warm compresses help dilate the veins and lymphatics, so they can clear the blood that has caused bruising and the fluid that caused swelling.

Keeping your head elevated, and avoiding strenuous activity will also reduce bruising and swelling.

Karen Vaniver, MD
Kennewick Plastic Surgeon
5.0 out of 5 stars 37 reviews

Cold compresses after surgery

Cold compresses in the first 48 hours are helpful in reducing swelling and discomfort.  Beyond that period the nature of compresses probably make little to no difference to you recovery.  Warm compresses can sometimes be useful in breaking clots, but highly doubtful if it actually makes any difference.  So, don't stress too much over the compresses.

A. John Vartanian, MD
Glendale Facial Plastic Surgeon
5.0 out of 5 stars 16 reviews

Compresses after Eyelid Surgery

Eyelids have a very good blood supply.  For that reason they heal very well.  However they also bruise and swell very easily.  Cold compresses constricts blood vessels .  That reduces bruising and acute (sudden) swelling.  I suggest that my patients use cold compresses for the first 3-4 days.  Warm compresses dilate the blood vessels and help you body do what it needs to to break down the bruise and carry away long term swelling.  So that is generally better after 3-4 days.

However, eye swell very easily and some patients notice that during the few weeks following surgery they have sudden episodes of swelling.  If that happens, it is best to switch back to cold compresses for a few days.

The bottom line is that cold compresses are the most important because they help prevent the problem of bruising in the first place.  The less bruising, the shorter your recovery. 

Marc Cohen, MD
Philadelphia Oculoplastic Surgeon
4.8 out of 5 stars 24 reviews

What to expect after eyelid surgery

While there is not a lot of scientific evidence here, the idea is that cold compresses control swelling only for the first couple of days. Then warmth brings extra blood flow to the area that will help "flush" out the fluid that has accumulated

Jeffrey M. Joseph, MD
Newport Beach Oculoplastic Surgeon
5.0 out of 5 stars 14 reviews

Cold first, then warm

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. 

Anand D. Patel, MD
Brookfield Facial Plastic Surgeon
5.0 out of 5 stars 19 reviews

Post op treatments

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,


Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.