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The Effect of Eyelid Cooling on Pain, Edema, Erythema, and Hematoma after Upper Blepharoplasty

A Randomized, Controlled, Observer-Blinded Evaluation Study

Pool, Shariselle M. W. M.D.; van Exsel, Denise C. E. M.D.; Melenhorst, Wynand B. W. H. M.D., Ph.D.; Cromheecke, Michel M.D., Ph.D.; van der Lei, Berend M.D., Ph.D.

Plastic and Reconstructive Surgery: February 2015 - Volume 135 - Issue 2 - p 277e–281e
doi: 10.1097/PRS.0000000000000919
Cosmetic: Original Articles

Background: The purpose of this study was to investigate the efficacy of eyelid cooling to reduce postoperative pain, edema, erythema, and hematoma after upper blepharoplasty.

Methods: After bilateral upper blepharoplasty in 38 consecutive patients, one eyelid per patient was randomized for cooling with an ice pack, and the other eyelid was left uncooled. Pain was scored by the patients using a visual analogue scale (0 to 10) 1 hour and 1 day after surgery. Degree of edema, erythema, and hematoma were scored by the patients on a four-point rating scale (no, minimal, moderate, or severe) 1 hour, 1 day, 1 week, and 2 months after surgery. Light photography was obtained 1 week after surgery for scoring the degree of bruising on a four-point rating scale by a blinded observer.

Results: Pain did not differ between cooled and uncooled eyelids on the day of surgery. However, pain in cooled eyelids was significantly lower 1 day after surgery (p = 0.046), yet absolute pain scores were low (median, 0 and 0.5, on a scale of 10). Edema, erythema, or hematoma did not differ between cooled and uncooled eyelids on any of the time points studied.

Conclusions: Cooling of eyelids after upper blepharoplasty does not reduce edema, erythema, or hematoma of the eyelids, but reduces pain 1 day after surgery. However, because the degree of pain seems clinically irrelevant and because the majority of patients indicate that they have no preference for cooling over noncooling, eyelid cooling after upper blepharoplasty as a rule of thumb can be abandoned.


Groningen, Zwolle, and Heerenveen, The Netherlands

From the Department of Plastic Surgery, University Medical Center Groningen; the Department of Plastic Surgery, Isala Clinics Zwolle; and Bergman Clinics Heerenveen and Zwolle, Private Clinics for Aesthetic Surgery.

Received for publication May 12, 2014; accepted June 5, 2014.

This trial is registered under the name “The Effects of Cooling of the Upper Eyelid Skin after Upper Eyelid Blepharoplasty,” Nederlands Trial Register identification no. NTR3799 (

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Berend van der Lei, M.D., Ph.D., Department of Plastic Surgery, University Medical Center Groningen, BB81, P.O. Box 30.001, 9700 RB Groningen, The Netherlands,

©2015American Society of Plastic Surgeons