Before surgery: what to prepare
Stop aspirin, ibuprofen, naproxen, fish oil, vitamin E, ginseng, and ginkgo for 10–14 days. Bruising under the eye is hard to avoid; reducing blood-thinning supplements is the main lever. No alcohol for 48 hours. Arrive with a clean face: no makeup, no contacts. Bring sunglasses for the ride home and for the first week in public. If you have any history of dry eye or have had LASIK or LASEK, mention it explicitly, lower blepharoplasty can transiently worsen dry eye and the surgical plan may include preserving more skin or using a transconjunctival approach to protect the orbicularis muscle. Pack preservative-free artificial tears for the first 4 weeks; grittiness is common and is managed before it becomes corneal irritation.
The day of surgery
Lower blepharoplasty is performed under local anaesthesia with sedation or light general, runs 60–120 minutes depending on whether the approach is transconjunctival (incision hidden inside the lower lid, no skin scar) or sub-ciliary (external incision just below the lash line, used when skin needs to be removed), and discharges same-day. You leave with steri-strips or tape under the lower lids, sometimes a thin pressure dressing for the first night. Vision is briefly blurry from ointment.
Days 1–3: peak swelling
Swelling and bruising peak day 2–3 and are usually more pronounced than upper lid surgery because the under-eye area bruises easily. Expect black-and-blue under both eyes, this is normal and resolves over 2 weeks. Cold compresses (10 on, 10 off) for 48 hours. Head elevation on two pillows is more important here than for any other facial procedure because gravity-driven swelling pools under the eyes. No bending, no lifting, no salty food. Pink oozing is normal in the first 24 hours.
Week 1: stitches out, bruising fades
Transconjunctival cases have no external sutures to remove and the recovery is mainly about waiting for bruising to fade. Sub-ciliary cases have sutures removed at day 5–7. Bruising has shifted from black-purple to yellow-green by end of week 1 and can be concealed with colour-correcting makeup. The lower lid feels stiff and slightly numb to touch, normal and resolves over weeks.
Weeks 2–4: back to public
Office work and public-facing situations from the end of week 2. Visible bruising is largely gone by week 2 and fully gone by week 3 for most patients, though patients with Fitzpatrick III–V skin can develop post-inflammatory hyperpigmentation that looks like persistent under-eye darkness after the bruising itself has resolved, this fades over months and is helped by daily SPF and pigment-care topicals. Some residual lower-lid swelling reads as a slight tired look that softens through week 4. Sub-ciliary scar is pink and visible at conversational distance during weeks 2–3 and starts to fade. Contact lenses around week 2 only after surgeon clearance, longer if you had fat repositioning or have a history of dry eye. No eye rubbing for at least 6 weeks (8–12 weeks if you had fat repositioning to the tear trough). Lifting limit under 5 kg for the first 2 weeks and no head-below-waist positions (yoga inversions, picking things off the floor), both spike orbital pressure and trigger haematomas.
Months 2–3: swelling resolves
Lower-lid swelling resolves and the result begins to look like the goal. Sub-ciliary scars fade from pink toward your skin tone. The under-eye numbness from week 1 is mostly resolved but small patches of altered sensation can persist longer. If you had fat repositioning rather than fat removal, the deep contour change becomes more visible as the repositioned fat settles into the tear trough.
Months 6–12: the final result
Final result is at month 6 for most patients. Sub-ciliary scar maturation runs the full 12 months; properly placed it should be nearly invisible at conversational distance by month 6. The most common reason for late revision is residual lower-lid laxity (skin that needed to be removed but wasn't), this is assessed at month 6 minimum.
Red flags: when to call the clinic
Call the clinic the same day for: sudden severe one-sided swelling, vision changes that don't clear, pus or yellow discharge, fever over 38.5°C, double vision (rare but a specific risk of inferior oblique muscle injury), any lower lid pulling down and exposing the white below the iris (this is scleral show or ectropion, report at any point, not just past day 3, because early intervention with taping or massage prevents corneal exposure), or a hard painful lump. Go to an emergency room for sudden severe eye pain with vision loss in the first 48 hours, retrobulbar haemorrhage is the time-critical sight-threatening concern and needs treatment within hours. Mild lower-lid tightness, intermittent tearing, and asymmetric bruising are not red flags.