Preparing for Blepharoplasty: The Weeks Before Eyelid Surgery

Preparing for blepharoplasty means four things done in the weeks before the operation: a pre-operative assessment of your eyes and health, a review of anything that thins the blood, stopping smoking, and arranging the time off and help at home that a day-case operation still needs. The operation itself takes roughly 45 minutes to 1 hour for the upper lids and about 1 to 2 hours for all four, and you go home the same day, which is exactly why the preparation has to happen before you walk in¹.

I was in my late forties when I had all four lids done, and I prepared for it the way I prepare for a holiday: a list on the fridge, a bag packed too early, and a nagging sense I had forgotten something. Most of that list turned out to be useful and a few items were pointless. This is the cleaned-up version, with the reminder that runs through everything on this site: the instructions your own surgeon gives you are written for your eyes, and mine were not. If you have not yet had the consultation, the questions to ask before eyelid surgery come first, and the eyelid surgery pillar explains the operation itself.

The pre-operative assessment

The most important preparation is not something you do at home; it is the assessment where your surgeon checks your brow, your tear film and the tone of your lower lids, because those three findings decide which operation you are actually having. A dropped brow can masquerade as excess upper-lid skin, pre-existing dry eye can worsen after surgery, and a lax lower lid raises the risk of the lid pulling down afterwards².

Expect questions that feel unrelated to your eyelids. Your general health, blood pressure, any bleeding or bruising tendency, previous eye surgery including laser vision correction, thyroid problems and every medicine you take are all on the list. Thyroid eye disease that is still active is usually stabilised before any eyelid operation. If the surgery is meant to be functional, because hooding is blocking the upper field of vision, a documented visual-field test is what supports NHS or insurance funding, so that test belongs in this stage rather than after the date is booked¹.

Be honest about dry eyes. Dry eye is common in the general population, especially with age and in women after the menopause, and plenty of people have a mild version they have never named³. I mentioned, almost as an aside, that my eyes stung by the end of a screen day, and that one sentence changed how conservative my surgeon was prepared to be. Photographs are usually taken at this visit too. Ask to see them; they are the honest baseline you will compare against at three months.

Medicines, supplements and bleeding

Anything that thins the blood is reviewed well before the operation, because bleeding is the root of the one complication eyelid surgery is most careful to avoid: the rare retrobulbar haemorrhage, a bleed behind the eye reported at roughly 1 in 2,000 to 1 in 25,000. It causes pain, pressure and lost vision and needs immediate treatment, so reducing the chance of it starts weeks ahead⁴.

The usual list includes aspirin, anti-inflammatory painkillers such as ibuprofen, and some herbal supplements, all of which can increase bleeding and are commonly avoided before eyelid surgery⁵. Go through your bathroom cabinet rather than your memory. I had forgotten that the fish oil capsules I took every morning counted as a supplement at all, and I only remembered when I wrote out everything I swallowed in a week. Paracetamol was what I was told I could use for ordinary aches instead, but that is your surgeon’s call, not mine.

The rule that matters more than any list: if a doctor prescribed a blood thinner for your heart, a clot or your circulation, you do not stop it on your own. The surgeon and the prescriber agree a plan together, because stopping some of these medicines carries a risk of its own, and in some cases the operation is planned around them rather than the other way round. Bring the names and doses written down; “a little white tablet” helps nobody.

Smoking, alcohol and your general health

Surgeons strongly advise stopping smoking before blepharoplasty, because a non-smoker in reasonable general health with realistic expectations is the standard description of a good candidate, and smoking slows wound healing. Many surgeons ask for several weeks without cigarettes before and after the operation, and the period they give you is the one to follow⁵.

The same logic extends further than people expect. Nicotine itself narrows blood vessels, so patches, gum and vaping are worth raising rather than assuming they are a safe swap. Alcohol is best kept modest in the days before surgery, since it can encourage bruising and swelling, and any cold, cough or eye infection in the week before is a reason to phone the clinic rather than push on. Blood pressure that is high on the day can increase bleeding, so if yours runs high, getting it properly controlled is part of the preparation. Blepharoplasty is among the highest-satisfaction facial procedures, with most series reporting well over 85% patient satisfaction, and starting from good health is part of how people end up in that group⁵.

Booking the time off and the help

Plan for 7 to 14 days before you feel presentable, about 2 weeks without contact lenses or eye makeup, and about 2 to 3 weeks before strenuous exercise, and book your leave, your help and your diary around those numbers rather than around the date of the operation. Bruising and swelling peak at 2 to 3 days and settle over 1 to 2 weeks, and upper-lid stitches usually come out at 5 to 7 days¹.

I took a fortnight off and kept it low-key, and it was the right amount for me; anyone with a job that involves strain, heavy lifting or a lot of screen time may want more. Avoid booking anything social or photographed for the first few weeks, and remember that the last swelling resolves over weeks to a few months, so a wedding a month later is cutting it fine.

You will need someone to drive you home. Nobody drives after eyelid surgery: the eyes are swollen, often smeared with ointment, and if you have sedation or a general anaesthetic your judgement is affected for the rest of the day. My partner collected me and stayed that night, and my sister came over for the next two days, mostly to fetch compresses and stop me reading. If the stitch removal appointment is a journey away, arrange that lift too. The differences between local, sedation and a general, and how each changes the day, are set out in blepharoplasty anaesthesia.

Getting the house ready

Setting up the house before the operation means having the things you will need in the first week within reach of the chair or bed you will be propped up in, because bending, lifting and hunting through cupboards all wait while the lids heal. Straining and bending raise pressure in fresh lid tissue, and the first days are spent with the head raised and cool compresses on the eyes⁵.

My list, trimmed to the items I actually used: an extra two or three pillows for sleeping propped up, clean soft cloths and a bag of frozen peas wrapped in one (or proper gel packs), the lubricating drops and ointment the surgeon prescribed already collected, glasses in an up-to-date prescription, sunglasses, button-front tops so nothing goes over the face, and food that needed no stooping into a low oven. A large-print note of the clinic’s daytime and out-of-hours numbers went by the phone, because reading small print with ointment in your eyes is harder than it sounds.

What I bought and never used: a special eye mask, a stack of books (I could not read comfortably for days) and an expensive scar cream I was later told not to start without asking. The practical routine once you are home is in blepharoplasty aftercare.

The day before and the morning of surgery

On the day, arrive with clean skin, no makeup and no contact lenses, follow the fasting times you were given exactly, and bring your companion, your glasses and your medicine list. Upper blepharoplasty is usually done under local anaesthetic, with or without sedation, while lower, combined or double-eyelid procedures may use sedation or a general anaesthetic, and that choice sets the fasting rules⁶.

Fasting matters if you are having sedation or a general anaesthetic, and the clinic will give separate times for food and for clear fluids; under local anaesthetic alone some clinics allow a light breakfast. Take your usual medicines on the morning only as you have been told, which may mean taking some and holding others. Wash your face the night before and leave off moisturiser and eye creams in the morning, because the surgeon marks the incision lines on the skin with you sitting upright. Wear something comfortable that opens at the front.

My own morning was undramatic. I had local anaesthetic with light sedation, so no breakfast, and I spent the wait trying not to touch my face while a nurse checked my list for the third time. The marking took longer than I expected and was oddly reassuring: watching the surgeon measure each lid against the other made the whole thing feel precise rather than rushed.

The plan for if something feels wrong

The last piece of preparation is knowing, before the operation, who you call if something goes wrong in the first hours and days, because pain with pressure and a change in vision can signal a bleed behind the eye and needs same-day treatment. It is rare, roughly 1 in 2,000 to 1 in 25,000, but it is the reason clinics give out an emergency number⁴.

Ask at the pre-operative visit what the out-of-hours arrangement is, who answers, and where you would be seen. Keep the number on paper as well as in your phone. Dry, gritty or watery eyes, blurred vision from ointment, and some difficulty closing the eyes fully are common early after-effects and usually settle; a lower lid pulling down, spreading redness and heat, or anything getting worse rather than better is a call to make, not a symptom to search². I never needed the number. I was glad, every night of that first week, that I knew exactly where it was.