Local anesthesia preferred for blepharoplasty

Upper eyelid blepharoplasty can be safely performed under local anesthesia in most patients. The preoperative workup of a patient for blepharoplasty is important in assessing the anesthetic and surgical risks of a patient. Your surgeon should be qualified in the surgical and perioperative managment of patients undergoing surgery. 

Upper eyelid blepharoplasty can be performed under general anesthesia and conscious sedation, however, local anesthesia with or without an anxiolytic is preferred.

Hi Carole,

Upper and lower eyelid surgery is usually performed in my office under anesthesia.  Local anesthesia with "adrenaline" is injected just under the skin about 5 to 10 minutes prior to the treatment.  The only exception is if there is excessive fat pad protrusion in the lower lids, then I prefer having the patient under sedation anesthesia.  Choose your surgeon carefully. Good luck.

Dr. P

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I'm assuming you are asking about which anesthetic options you have, not whether or not local anesthesia is needed.  Almost all doctors in this country will use a local anesthetic while performing any blephaorplasty surgery, for the reasons listed in the posts below.

Local anesthesia - Almost any surgery can be done under local anesthesia.  Upper blepharoplasty alone, with or without remodeling of the fat, can be performed under local anesthesia.  The patient is completely aware that surgery is being performed.  This can be an anxiety-producing, even traumatic experience for the patient.

Oral sedation - Patients having a blepharoplasty under local anesthesia often will request valium or a similar oral medication.  This "takes the edge off" the anxiety the patient might otherwise experience during the surgery.

IV sedation - Local anesthesia can be supplemented by IV sedation.  For light IV sedation, i.e. versed in small doses, a monitored setting is usually adequate.  It is not acceptable to administer versed in an office without monitoring in my opinion.

IV Sedation - Local anesthesia with IV sedation.  Often called "twilight" sleep, many surgeons will use a board certified anesthesiologist to administer the sedation.  This provides extra safety in a deeply sedated patient.  The patient is usually minimally aware or unaware of the surgery. 

Light general anesthetic - In our practice this is performed by a board certified anesthesiologist.  The patient goes to sleep, and when they wake up, the surgery is done.

For upper eyelid surgery, often skin is removed from the upper eyelid crease.  The fat is often reduced or remodeled.  In revision cases, often fat fascial grafts (LiveFill) are used to restore fullness and reduce hollowness.  If there is brow drooping, this should be considered as well since eyelid surgery does not fix brow drooping.  Asymmetries or the eyes and brow, differences in the set of eyes (i.e. orbital dystopia), conditions which may be affected by the eyes (dry eye, lid laxity, ptosis or drooping of the eyelid muscle) should all be considered and a plan formulated to treat them.

For lower eyelid surgery, this is a much more complex issue.  Asymmetries are very important to consider preoperatively, as well as the set of the eyes.  Whether fat reduction from inside the eye combined with resurfacing on the outer eyelid (transconjunctival blepharoplasty), remodeling of the fat or grafting (arcus marginalis repair or LiveFill), cheek lifts (subciliary, minimal incision, augmentative- i.e. USIC or LUSIC, Endotine, temporal/intraoral).  All of these should be carefully planned prior to surgery and your doctor should be fluent in these techniques.

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