We commonly do upper eyelid blepharoplasty under local anesthesia in our office operating room. There is rarely a reason not to do it this way. It takes less than an hour. In the lower eyelid, however, just local anesthesia can be a bit risky. If all that is being done is cauterizing or removing some fat from the lower eyelid, it can be safe. We used to do this with a laser all the time. However, if the surgeon is moving fat from your lower eyelid into what is called the tear trough, our more common procedure today, you should at least have some sedation for comfort and safety reasons. The difference between conscious sedation and a general anesthesia with what is called an LMA tube is often just a matter of a small change in the dose of the drugs. We do this through a transconjunctival approach. Nausea and vomiting after general anesthesia for this procedure should be very rare. I have attached a link.
I perform four lid blephs under intravenous sedation. For upper lids alone and even some four lid blephs that are straightforward, I now offer oral medication which saves the anesthesiologist fee. I have never used general for a bleph. Regardless, you should have a board certified anesthesiologist in an accredited facility. If you reported your car sickness, etc,, to your surgeon, he may have concluded that general would give you an easier recovery but I encourage you to clarify this well in advance of surgery.
Local anesthesia with sedation, poorly monitored is more dangerous than general anesthesia given by a board certified anesthesiologist. Because anesthesiology has gotten so safe over the years many of us use it. The risk of heart beat slowing while working on the lower eye pads is better managed by an anesthesiologist. So if you opt for another surgeon that uses local, insist an anesthesiologist be in the room. He is your insurance.
You will get different answers as you can see already. In most cases; however, general anesthesia is unnecessary for simple skin +/- fat excision blepharoplasty that should take 45-60 minutes to perform. Having the patient be able to open the eyes on command allows the surgeon to perform small adjustments during the procedure. This is impossible when the patient is intubated under general anesthesia. I generally can perform most upper eyelid surgery under local anesthesia with oral sedation. For patients that are more anxious IV sedation works well. Only in rare cases where the patient is extremely nervous is general anesthesia ever necessary. There are surgeons who feel more comfortable performing surgery under general, but I do believe patients should have input into how their anesthesia is to be performed and you should feel comfortable discussing your concerns with your surgeon. There may be extenuating circumstances with your case that he feels general anesthesia would be safer for you.
Although personally I never use general anesthesia for blepharoplasty, it certainly is not wrong to opt for this anesthetic approach. If your surgeon has always done it this way he will not change his personal practice for you. If you trust his aesthetic eye, experience and care, you likely can trust his choice of anesthesia.
General anesthesia is reasonable for bleph especially if a lot work is to be performed. General anesthesia is safe. Blephs can be performed with local anesthesia or sedation as well. If you have confidence in your surgeon then you should lean on his judgement.
Earl Stephenson, Jr., MD, DDS, FACS
- General anesthesia is extremely safe and safer than sedation,
- Conscious sedation requires you to breathe on your own while sedated - serious complications can occur if you do not breathe adequately,
- Your surgeon is giving you good advice, take it.
- A scopalamine patch, pre-operative sedation, ondansteron afterwards and intravenous steroids during surgery all help with the nausea. Best wishes.
We perform most blepharoplasty surgery under local anesthesia. I don't think general anesthesia is needed for most eyelid surgeries. Talk to your doctor or find someone who will use local anesthesia.
Rountinue upper and lower blepharoplasty can be done under local anesthesia with or without sedation in most patients. The only discomfort endured is the injections to numb the areas to be worked on. However, if there are extensive fat pockets to contour or fat to translocate, it may be difficult to keep you comfortable during this. If you are part way thru the surgery and the local anesthesia is not keeping you comfortable, there is usually not an anesthesiologist waiting to put you to sleep. Your surgeon likely has good reasons for choosing general anesthesia for your surgery and you should realize it is a very safe option for surgery and there are many medications available to help you deal with any nausea, etc.
Thank you for your question. Routine four lid blepharoplasty can certainly be done under intravenous sedation. However more complex lower blepharoplasty which includes arcus release and fat grafting requires manipulation of the tissues at the level of the orbital bone and can cause discomfort that cannot be controlled with local anesthesia. In my experience patients do much better with general anesthesia when these advanced blepharoplasty techniques are used.