Background <p>Bupleurum and Hoelen combination (BHC) extract has traditionally been used as a folk remedy for treating inflammation-related conditions. However, its effectiveness in reducing swelling after facial surgery has not been sufficiently investigated. In this study, we sought to determine the potential benefits of BHC extract for treating post-blepharoplasty ecchymosis and oedema.</p> Methods <p>In this observer-blinded randomised controlled trial, a single surgeon performed upper blepharoplasty for ptosis in 45 patients. The intervention group received a Chinese herbal medicine preparation of the BHC extract orally for 7 days postoperatively. Postoperative oedema and bleeding were examined by checking for bleeding spots and oedema in the upper eyelid area on postoperative days 1, 4, 7, and 14.</p> Results <p>Patients who received the BHC extract showed reduced oedema in the upper eyelid on postoperative days 1, 4, and 7, based on subjective assessments, compared with those in the control group. The bleeding spot score on postoperative day 1 was significantly lower in the BHC group than in the control group. In the objective evaluation, similar to the subjective evaluation, upper eyelid oedema symptoms were significantly reduced in the BHC group compared with those in the control group on postoperative days 1, 4, and 7. The number of bleeding spots was significantly lower in the BHC group than in the control group on postoperative days 1, 4, and 7.</p> Conclusions <p>Based on the beneficial effects of the BHC extract on post-blepharoplasty ecchymosis and oedema, we propose the appropriate use of the BHC extract.</p> Level of evidence <p>Level Ⅰ, therapeutic study.</p>