Lower Eyelid Swelling After Eyelid Treatments
Posted: 6:00 a.m. Sunday, Aug. 26, 2018
By Anita Mandal, M.D.
Question: I had an upper eyelid lift 10 years ago for baggy upper eyelids. I had a good result, but there was swelling under my eyes that looked like fluid bags and didn’t go away for a long time. Now I’ve aged in the last 20 years and a plastic surgeon advised a second eyelid lift. I’m terrified about the swelling after surgery since the first time I had swelling for over 6 months. Will I experience the same prolonged swelling and fluid bags under my eyes?
Answer: The eyelid tissues are a very delicate area. Whether you have surgery or even a minimal-invasive procedure, this area, especially the lower eyelid, is more prone to bruising and swelling than other facial areas. In some patients, swelling can last 6 months or longer. In 20 years of practice, I’ve had one patient with prolonged swelling that lasted nearly one year after having eyelid surgery. Prolonged swelling can also occur after laser treatments and even fillers in or near the eyelid area.
In patients with prolonged swelling, particularly when it looks like fluid bags, there is often an underlying issue with the body’s lymphatic system around the eyes. Typically, the lymphatic system drains toxins and fluids from an area and is found throughout the body and face. As you age, this lymphatic system can slow down or even get blocked, resulting in a buildup of fluid. Have you ever seen someone with puffiness in their upper cheeks and lower eyelid area where the swelling tends to go up and down as the day goes by? Sometimes, it’s worse in the morning due to the effect of gravity when they are laying flat in bed and better during the day as they are upright. This is not due to excess skin or bulging eyelid fat but an impaired lymphatic system.
Sometimes, allergies and salt intake can also contribute to the puffiness. While lymphatics can slow down or get blocked anywhere in the face, it’s often more visible under the eyes due the thinness of skin in this area.
Given your history, you likely may have blockage of the lymphatic system as a pre-existing condition which contributed to the prolonged swelling after surgery. There is not a definite way to predict in advance if you will have prolonged swelling from blocked lymphatics. Whenever patients undergo any kind of procedure around the eyes, regardless of whether it’s surgery, laser or fillers, lymphatic blockage can show up as prolonged eyelid swelling, especially in the lower lid area.
The good news is that swelling, no matter how long it lasts, typically goes away with time. If you’ve had more than expected, persistent swelling past 4-6 weeks after an eyelid procedure, certain steps can be taken to help. Depending on the situation, I may recommend a lymphatic massage specialist to massage the involved areas in the proper direction to open up your lymphatics, allowing fluid to drain more effectively. It’s important to see a skilled lymphatic specialist since there are many aestheticians who claim to know this technique but are unable to give effective results. In addition, reducing your salt and alcohol intake, using an antihistamine and possibly a steroid dose pack may help. However, I typically wait at least a month or longer before pursuing these approaches to see if the swelling resolves on its own.
If you experience prolonged puffiness after an eyelid treatment, it’s important not to panic. Stay calm and if after a month, the swelling is not significantly improved. It may be due lymphatic blockage. Evaluation 4-6 weeks after treatment by your plastic surgeon is the first step.