Lower eyelid surgery recovery: week by week, and the risks worth knowing

Bruising and swelling after lower eyelid surgery (lower blepharoplasty) mostly settle over a few weeks, but swelling of the eye's surface can last for months, and the rare emergency to know is bleeding behind the eye. This page sets out the usual timeline as hospitals publish it, the risks specific to the lower lid, and when to call urgently.

Published recovery guidance is written mostly for eyelid surgery in general, and the lower lid has its own quirks, so each figure below is given as typical and variable. Your own surgeon's written instructions come first. I set out the same ground for the upper lid in my page on upper blepharoplasty recovery, and the wider range is in the eyelid surgery recovery timeline. For recovery decisions in general, see the decisions section.

Which approach is used for lower eyelid surgery, and does it change recovery?

There are two routes. Transconjunctival surgery goes through the inside of the lower lid and leaves no skin scar; transcutaneous surgery goes through a cut just below the lashes and allows skin to be removed. The NHS describes both: an incision either just below the lower lashes or on the inside of the lower eyelid.

Which suits which lid is explained in my article on lower blepharoplasty and eye bags. For recovery, the practical difference is that a cut below the lashes needs stitches or strips that are later removed, and a 2026 paper notes that this route has been associated with scleral show and lid malposition, because removing skin can pull the lid down. Either way, the first weeks look similar from the outside: swelling, bruising and a tight, dry feeling.

What happens in the first 24 hours and the first week?

Swelling and bruising build over the first days, vision may be a little blurred, and the eyes feel gritty and tight. Hospital leaflets describe cold packs, sleeping propped on pillows, lubricating drops or ointment, and a check at about one week.

A Cambridge University Hospitals leaflet describes the pattern for eyelid surgery in general: ice packs from the start, remaining upright as much as possible and sleeping with the head raised, lubricant drops or ointment for grittiness, and stitches usually removed at a clinic visit about a week later. Slight blurring right after surgery is common and usually clears with blinking, partly because of the ointment. The same leaflet says to alert your surgeon if vision stays severely impaired beyond 24 to 48 hours and does not clear with blinking. Where a lower lid is done from the inside, there may be no skin stitches to remove at all; the surgeon says which applies.

How long do bruising, swelling and chemosis last?

Bruising usually fades within about two weeks, according to the Cambridge leaflet, though the NHS says bruises and redness may take several weeks to fade. Lid swelling subsides faster than the tightness or the surface swelling called chemosis.

Chemosis is swelling of the conjunctiva, the clear skin covering the white of the eye, which can look like a glassy blister along the lower lid. The Cambridge leaflet says it is typically associated with lower eyelid surgery and can last several weeks or months. A 2024 paper of 1,047 lower blepharoplasty patients, comparing transconjunctival and transcutaneous routes, cites published rates of chemosis lasting two or three weeks of between 1% and 34.5%. If it appears, my article on chemosis explains the causes, and a surgeon should look at it rather than leave it to guesswork. The NHS adds that scarring may be visible and feel tight for a few months.

When can I go back to work, exercise, driving and make-up?

The NHS says most people take about two weeks off work. You will not be able to drive for a number of days. The Cambridge leaflet, written mainly with upper lid surgery in mind, says light exercise and a normal work pattern may resume within a few days and eyelid make-up from about two weeks.

Those are general eyelid-surgery figures, and a desk job and a job that involves lifting are not the same. Strenuous exercise and anything that raises blood pressure are generally held back longer, because blood pressure matters for bleeding, as the warning-signs section below explains. Sunglasses protect the eyes from sun and wind, and sun on a fresh scar line is a separate concern. If scar and pigment care is on your mind, the Retreat Clinic has written about scar and pigment care after eyelid surgery, from the skin side.

What helps recovery?

Cold packs, a raised head, lubricating drops or ointment, and keeping to the follow-up visit are the common measures. Controlling blood pressure matters too, since hypertension was the most commonly reported risk factor in a survey of visual loss after blepharoplasty.

Two cautions. First, the Cambridge leaflet advises avoiding aspirin and aspirin-containing treatments to reduce the risk of bleeding and bruising, but follow the written instructions you are given, and do not stop a prescribed medicine on your own. Second, dry, gritty eyes are common, and are more likely if the eyes were dry before surgery; my article on dry eye after eyelid surgery covers what to do about it.

What are the specific risks of lower eyelid surgery?

The lower lid has its own set: a lid pulled downward or outward, whites showing below the iris (scleral show), asymmetry, dry eye and persistent chemosis. They are uncommon in published series, but they are the reason the position of the lid is assessed before surgery.

A literature review of 49 studies and 10,698 lower blepharoplasty patients pooled reoperation at 0.77%, scleral show at 0.37%, lid malposition at 0.25% and ectropion (the lid turning outward) at 0.24%. The same review points out that follow-up was short, a mean of 14.8 months in the studies that reported it, so it says little about the long term. A review of the anatomy explains the usual causes of ectropion and scleral show after lower lid surgery: too much skin removed, damage to the nerve supply of the muscle in the lid, scarring that pulls the lid down, or a weak lid support. The NHS lists the lower lid drooping away from the eye and turning outward among the more serious problems, and my article on ectropion and the article on eyelid retraction after surgery explain how those are assessed and treated.

If excess skin removal has left the eye unable to close fully, the cornea can dry. The Cambridge leaflet says excessive skin removal may cause poor blink and inability to completely close the eye, with a dry, uncomfortable eye, and that the risk is greater if the eyes are already dry. That is a recognised complication, not evidence that anyone made an error. What each warning sign means is set out in the article on recognised complications after eyelid surgery.

What are the warning signs of bleeding behind the eye, and when do I call urgently?

Call the surgeon or go to an eye emergency service at once for severe or worsening pain, a feeling of pressure, a tense or bulging eye or lid, or any loss, dimming or doubling of vision. Bleeding behind the eye (retrobulbar haemorrhage) is rare, but it can threaten sight, and speed matters.

A survey of 752,816 blepharoplasties reported visual loss at about 1 in 20,000, with permanent loss at about 1 in 30,000; the Cambridge leaflet quotes roughly 1 in 22,000 per side. In the survey, pain and pressure were the commonest symptoms, symptoms usually began within the first 24 hours with peaks in the first postoperative hour and at six to 12 hours, and retrobulbar haemorrhage was the main cause of blindness. A systematic review of 93 reported cases of retrobulbar haematoma, three quarters of them after trauma, found full visual recovery in 51%, partial recovery in 27% and blindness in 22%, and shorter time to treatment predicted full recovery. Bleeding is not limited to the first day: one report describes two cases five and eight days after upper blepharoplasty, in both of which uncontrolled blood pressure appeared to be the trigger. So blood pressure care continues after the first night.

Anything else unexpected, such as a hot, red, swollen, discharging lid, fever or a lid that will not close, also needs the surgical team that day. If you cannot reach them, an eye casualty or emergency department is the place. The wider picture of how eyelid findings link together is in my hub article on why eyes look tired.