After eyelid surgery, which pantang rules have evidence? Soy sauce, seafood, hair washing and more

After eyelid surgery, most families hand down a list of rules. In Malay homes it is called pantang, the things you must not do or eat while you heal. In Chinese homes it is the food beliefs about soy sauce, seafood, chicken and "heaty" dishes. Some of these rules have evidence behind them, many are harmless, and a few matter more than people expect. I would sort them into three piles: what is supported, what is tradition that does no harm, and what is worth asking your surgeon. This piece follows the same order, and the day-by-day picture of healing is in my guide to the first six weeks.

Do the pantang rules after eyelid surgery matter?

Some do, but not the ones people argue about most. The rules with the strongest support are about bleeding, swelling, smoking and sun, not about soy sauce or chicken. A written list of prohibitions also tends to hide the useful point: most of the work of recovery is done by the wound itself, and a handful of sensible habits protect it. I would rather you keep four or five rules for good reasons than twenty for no reason.

I also want to say plainly that tradition and surgery are not enemies. A rule that reassures a family and costs nothing is not something I would argue against. The line I draw is at a rule that stops you eating well, delays a medicine you need, or replaces a call to your surgeon when something is wrong.

Which recovery rules have real evidence behind them?

Four have reasonable support: keep your head raised for a few days, avoid strenuous exercise early, do not smoke, and tell your surgeon about every medicine and supplement that affects bleeding. The fifth, sun protection on the scar, is covered further down. Hospital leaflets agree on these more than they agree on anything else.

Head elevation. The NHS advises propping your head up with pillows for a couple of days when resting, to reduce swelling. A hospital leaflet from Cambridge describes sleeping with the head raised on several pillows for the same reason, and one from Bath says to use one or two extra pillows until the swelling settles. This is advice from leaflets and expert practice, and I did not find a trial that tested it, so it is a sensible habit rather than a proven one.

Exercise. The NHS advises avoiding strenuous activity and swimming for a few days, and Moorfields Private says to avoid strenuous activity for one week. A Singapore National Eye Centre leaflet adds that contact sports are best avoided for three to four weeks. The reason is bleeding: raising your pulse and blood pressure can make a fresh wound ooze or swell. The Cambridge leaflet says most forms of light exercise can resume within a few days.

Smoking. A systematic review of 60 observational studies found that in cosmetic surgery, smokers had about 2.3 times the odds of a wound infection and about 2.5 times the odds of delayed wound healing. Eyelid surgery was not separated out, but the principle holds. Leeds Teaching Hospitals says smokers are known to have healing problems and asks patients to tell the surgeon. If you smoke, this is the single rule I would work hardest to keep.

Medicines and supplements. The NHS says your surgeon needs to know if you take medicines that reduce the risk of blood clots. A review of antithrombotic therapy in eye plastic surgery says the decision to continue or stop should be made with the doctor who prescribed the medicine, because stopping has its own risk. It also lists supplements with an antithrombotic effect, including garlic, Ginkgo biloba, ginger, ginseng, fish oil, vitamin E and selenium. Some traditional tonics and everyday supplements contain these, so mention them as you would a tablet. Do not stop a prescribed blood-thinning medicine on your own.

Sun protection. The NHS advises keeping a scar covered in the sun for at least one year and using sunscreen of SPF 30 or more. On the eyelid that means sunglasses and a hat first, and sunscreen once your surgeon confirms the wound has closed. I explain why in my article on eyelid scars.

Do cold packs and sleeping propped up really help?

Cold packs probably help comfort more than swelling. A randomised trial of 38 people having both upper lids done put an ice pack on one lid and nothing on the other. Swelling, redness and bruising did not differ between the two sides at any time point. Pain was lower on the cooled side the next day, though the scores were low in both. The authors concluded that routine cooling could be abandoned as a rule of thumb.

That sits oddly beside the leaflets, which still suggest cold packs, for example frozen peas wrapped in a tea towel for the NHS, or an ice pack for 15 to 20 minutes up to twice a day in the Bath leaflet. Moorfields adds that the eye area should stay dry for a few days. My reading is that a cool pack is a kind, cheap comfort and does no harm if you follow your surgeon's instructions, but you need not feel you failed if it was not done on schedule. The trial studied upper lids only, so it does not settle lower lid surgery.

Does soy sauce darken eyelid scars, and what about seafood, chicken and heaty food?

I did not find any study showing that soy sauce, seafood or chicken change how an eyelid scar heals. The belief that soy sauce darkens a scar is widely held in Chinese and Malay households, but pigment in scars is shaped by other things, and a review of scar pigmentation calls the pattern of repigmentation unpredictable. The NHS notes scars can be pink, red, brown or darker than the surrounding skin.

What does have support is the sun. UV protection of early scar tissue is part of international scar guidelines, and the NHS advice above is specific. If you want a rule that protects colour, that is the one. A guideline on scars in Asian patients also notes that Asian skin has a tendency towards hyperpigmentation, which is a reason to take sun care seriously rather than a reason to avoid sauce.

Chicken and seafood are a different case. A dietitian reviewing the belief for SingHealth says traditional Chinese medicine advises avoiding them because they are thought to affect wound healing, that there is little evidence for this, and that both are good sources of protein, which the body needs to heal. I agree with that. Cutting out protein for a fortnight in the name of tradition is the one food rule I would gently challenge.

Heaty foods such as durian, lychee, fried food and spicy dishes belong to a different system of thinking, and there is no trial testing them against eyelid healing. If avoiding them for a week makes you feel cared for, nothing is lost, provided you still eat enough. If a dish upsets your stomach, skip it for that reason.

What about washing hair, hot showers, make-up, screens, flying and alcohol?

For these, the honest answer is that I found no good trials, and the leaflets give different advice. That makes them questions for your own surgeon, whose stitches and technique you are actually healing from.

• Hair and showers. Moorfields says to keep the eye area dry for a few days. How to wash your hair and face in that time, and whether hot water is allowed, is your surgeon's instruction, and I found no study that tests it.
• Make-up. Cambridge says eyelid make-up from about two weeks; Norfolk and Norwich says about four. The difference shows why timing is your surgeon's call, based on how the wound has closed.
• Screens and reading. I found no evidence that screens harm healing. The practical issue is that eyes can feel dry and gritty, and the Norfolk and Norwich leaflet suggests lubricant drops or ointment for that. The article on dry eye after eyelid surgery goes into it.
• Flying and alcohol. The NHS page does not address either, and I did not find a study for eyelid surgery. Ask, particularly if you are travelling soon or taking painkillers.
• Contact lenses and rubbing. The NHS advises avoiding both, and Moorfields advises avoiding contact lenses during recovery.

What should you ask your surgeon, and when is a rule really a warning sign?

Ask for a written list that covers your own surgery: how long to keep your head raised, when exercise and make-up are allowed, which of your medicines and supplements to continue, and when to wash your hair. Then add anything your family has told you. A surgeon would rather hear about a herbal tonic before the operation than after a bruise.

Separate a rule from a warning. Swelling and bruising are expected; the NHS says they take several weeks to fade. What is not routine is severe pain, swelling that is much greater on one side, falling vision or bleeding that does not stop. A Norfolk and Norwich leaflet asks patients with severe pain and excessive lid swelling to ring the eye casualty, and notes that severe bleeding around or behind the eye, though extremely rare, can cause loss of vision. Do not wait for a pantang period to end. The wider list is in my article on recognised complications, and the upper lid timeline is in the week-by-week guide.

Dr Catherine Chow begins consulting at Eagle Eye Centre Malaysia, Petaling Jaya, from early 2027. Until then, follow the instructions of the surgeon who operated on you. For the bigger picture of decisions before surgery, see the Before you decide section and my hub article on why eyes look tired.