Is swelling worse on one side normal after blepharoplasty?

What's normal

The two sides almost never swell and deflate on the same schedule. StatPearls states that all patients will have some degree of bruising and swelling, which may last up to 2 weeks, and AAO puts bruising and swelling after upper eyelid surgery at typically 10 to 14 days. Within that window, a visible difference between the two lids is expected rather than alarming.

Several ordinary things make one side worse: which side you sleep on, how much work was done on each lid, how much local anesthetic went in, and whether one side bled a little more. StatPearls also notes lower eyelid puffiness is normally worse in the first hour or so after waking, when you are tired, and after salty meals, so the asymmetry you see at 7 a.m. may be gone by evening.

An AAO ophthalmologist answering a patient with swelling one week after blepharoplasty wrote that it is likely the swelling will settle down over the next week or two, with cool compresses, tear drops, and follow up with the surgeon.

Usually most pronounced in days 2 to 3, clearly improving by days 10 to 14, with small differences fading over 2 to 3 months.

When it stops being normal

Swelling that is getting worse instead of better, especially after the first 2 to 3 days, is the pattern to take seriously. AAO states that severe pain, decreased vision, and progressive swelling may represent retrobulbar hemorrhage and should be brought to immediate medical attention. That is an emergency, not a wait and see.

Also call if one side becomes hot, spreading red, and tender, or if you develop fever or discharge, since infection is among the possible complications of eyelid surgery per AAO. Persistent asymmetry that is still obvious at 2 to 3 months is a conversation for your surgeon, not an emergency.