Ask a doctor

Can Eyelid Surgery Be Done Without Anesthesia?

Can bleph eyelid surgery be done without anesthesia?  If so, how does it work?

Doctor Answers (60)

Eyelid surgery without anesthesia would be intolerably painful


Eyelid surgery or for that matter any surgery would be too painful to perform without any anesthesia. I suspect that you meant to ask whether eyelid surgery could be performed while you are completely awake under a local anesthetic alone. This would be comparable to having a cavity filled by your dentist with an injection of the local anesthetic in your gum.

In the case of blephroplasty or eyelid surgery, local anesthetic alone would suffice but I wouldn't recommend it. Patients undergoing eyelid surgery while completely lucid can't help but have an increase in their blood pressure because they are understandably nervous. This increase in blood pressure causes an increase in bleeding that clouds the operative field and makes the surgery more difficult.

I find that for eyelid surgery, the patient must be made unaware of the goings on and this implies the need for either intravenous sedation or general anesthesia. Think of how you might react to seeing the scalpel come near your eyes and you will understand my point.

Chicago Plastic Surgeon
5.0 out of 5 stars 65 reviews

Don't pass on the local anesthesia!


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

Michael A. Persky, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 23 reviews

Local anesthesia is my routine for eyelid surgery


Local anesthesia is my general routine for blepharoplasty. The local anesthesia injections in the eyelids are not painless, but relatively low pain. Some patients desire a little oral or IV sedation which is always a possibility.

York Jay Yates, MD
Salt Lake City Plastic Surgeon
5.0 out of 5 stars 42 reviews

You might also like...

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.

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 47 reviews

Eyelid surgery can be performed without general anesthesia.


Eyelid surgery can be performed without general anesthesia. It is reasonable to undergo upper eyelid blepharoplasty under straight local anesthesia. One can also perform some types of lower lid blepharoplasty procedures under local anesthesia as well. For some more aggressive procedures, patients will benefit from some sort of sedation or general anesthesia.

Sanjay Grover, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 102 reviews

Blepharoplasty with valium and lidocaine


I have a plastic surgeon who does these in my office and uses 5 mg of valium and local anesthesia. His patients are very pleased and are driven home by a friend or spouse. I have watched him do this in many patients and I don't perceive them to have any discomfort whatsoever! Dr. Raffy Karamanoukian (disclosure - my brother) also does these in his offices. I think it is well tolerated.

As a heart surgeon myself, I have done coronary bypass surgery on a dozen people who had eyelid surgery under general anesthesia and approximately a week later they had suffered a heart attack - it is related to the eyelid surgery in that any kind of general anesthesia risks coronary ischemia if there is undiagnosed coronary artery disease.

I therefore recommend that whether a blepharoplasty is being done under local or general anesthesia, that the doctor doing it screens you for possible heart problems by asking you some simple questions that are directed toward that.

Hratch Karamanoukian, MD, FACS
Buffalo General Surgeon
4.5 out of 5 stars 6 reviews

It could - but you wouldn't want it


Some form of anesthesia is needed to do any kind of surgery. There are generally three levels of anesthesia - local, sedation, and general. Local is similar to what most dentists will administer. It involves injecting numbing medicine at the area to be operated on. Sedation involves some sort of medication which alters a person's state of consciousness. In general sedation will not require a breathing tube and is fairly easy to rebound from. General anesthesia is what is thought about for most surgeries. In this type of anesthesia, the patient is completely asleep, requires a breathing tube and can take a day or two to recover.

Eyelid surgery can be done with any of the three types of anesthesia. Upper eyelid surgery is probably most commonly done using local anesthesia though there are circumstances where sedation or even general is necessary. Lower eyelid surgery is a bit more complicated. There is usually more involved with lower eyelid surgery than upper eyelid surgery and there is probably an even split to be able to perform the surgery using local, sedation, or general anesthesia. There is no answer for every situation and consultation with your surgeon, specifically expressing your wishes for the type of anesthesia are very important.

Hope this help.

D.J. Verret, MD
Dallas Facial Plastic Surgeon
4.0 out of 5 stars 12 reviews

Eyelid Surgery without General Anesthesia


Certain types of eyelid rejuvination can be done with only local anesthesia. More complex and deeper procedures involving fat or muscle work require sedation or general anesthesia. Local anesthesia is given with an injection (usually Lidocaine). No surgery on the body can be done without at least local anesthesia.

Upper and lower eyelid blepharoplasty where only skin needs to be removed can be done under local.

Look in the mirror and see if your upper eyelid skin appears to be excessive. Then note if your eyebrows have fallen significantly. Next look at the upper eyelid area below your eyebrow and to the side of your upper nose. See if that region looks puffy. If your eyebrows are still high and you don't have puffiness next to the nose, then a skin only procedure may be right for you.

For the lower eyelids, look to see if there is significant puffiness betwen the eyelid and the cheek. Look to see if your eyelid is tight against your eye and snaps back quickly after you pull it away from the eyeball. Look for wrinkling in the skin. If you only have wrinkled skin and your eyelid snaps back quickly, then a skin only lower eyelid procedure (skin pinch) may be the appropriate procedure for you.

Keep in mind that the eyelid region is very sensitive. Some patients (5-15%) are resistant to the effects of local anesthetics. You have to be a little tough to have a local-only eyelid procedure. Usually, I ask my patients if they are OK at the dentist. If they say yes, then local facial plastic procedures usually go well.

Richard W. Westreich, MD
Manhattan Facial Plastic Surgeon
5.0 out of 5 stars 16 reviews

Local Anesthesia in the Office is Great for Upper Eyelid Surgery

In our practice, I discuss all of the options with the patients and we decide together what form of comfort measures will be selected.  Having said that, the patients often will choose to use local anesthesia in the office with upper eyelid surgery.

We generally will use an initial specialized topical anesthetic for 30 minutes followed by local anesthesia after marking the patients.  This should not be a painful experience.

After the procedure, we always have a discussion with the patients during the first post-operative office visit to consider the success of the operative process.  One  thing we always go over is the comfort of the procedure and early post-operative period.  Honestly, most patients will remark that the procedure using local anesthesia was easier than they had anticipated.  None have indicated that they regret their decision to use local anesthesia.

There are types of lower eyelid surgical procedures that are poorly tolerated in the office using local and I will recommend some deeper form of anesthesia for those patients.

In the end, there are many options for patients and we always find a very suitable and comfortable solution individualized for each patient.

You might also consider asking the surgeon and coordinating team for the names of some patients who have had the procedure done in the same setting you are considering.  That can be very reassuring and helpful.

Best of Luck and thanks for your great question.
Dr. Hobgood

Todd Christopher Hobgood, MD
Phoenix Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews

Eyelid Surgery Be Done Without Anesthesia?

Upper eyelid surgery can often be done safely in the office under local anesthesia without the need for sedation.  Lower eyelid surgery can also be done the same way if there is only skin removal.  If prominent fat pads need addressed often sedation is necessary for the patient's comfort.

Susan D. Vasko, MD, FACS
Columbus Plastic Surgeon
4.5 out of 5 stars 3 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.