Does a patient need to be awake to open and close the eyes to judge the effect for the Upper Eyelid Surgery?

If you are referring to a blepharoplasty (removal of excess eyelid skin), the procedure can generally be done while the patient is awake or asleep.  If you are referring to eyelid ptosis (correcting a droopy eyelid or eyelids) then it is usually best to do the procedure while the patient is awake and can open and close his or her eyes during the procedure. 

The truth is that there is no substitute for patient cooperation to get the best eyelid results.  There is a great deal of mediocre eyelid surgery and marking a patient once and not checking eyelid markings with a patient opening and closing the eyes to confirm marks immediately before making an incision is a factor in bad results in my opinion.  I will not perform blepharoplasty on a sleeping patient.  Intravenous sedation with local anesthesia is ideal for eyelid surgery.

For a normal blepharoplasty, you don't need to be awake to open and close your eyes. The surgeon will mark your eyes before surgery then the surgery can be performed with you asleep. If you have a droopy eyelid (not excess skin of the eyelid, but rather the eyelid doesn't open as much as the other side) and the surgeon is going to correct the droopy eyelid, then you would want to be awake to see if the eyelid lifts better with the placement of a suture in the tendon that lifts the lid.

Andrew Campbell, M.D.

Facial Rejuvenation Specialist

Quintessa Aesthetic Centers

I patient does not have to be awake to assess the results of blepharoplasty.  The best way to assess is a conservative pinching of the skin before marking.  This shows you if the patient will still be able to close the eyes after removing that  much skin.RegardsDr. J

The most important part of the upper lid surgery is correct marking prior to the operation. The surgeon must consider the patients brow position in connection with the upper eyelids. Once the correct marking is made so that the upper lids can close completely in a sitting position, the surgery can be done with the patient awake or asleep. The great majority of my patients are done while asleep (conscience sedation). Please consult with and experience facial plastic surgeon to be evaluated.

My marking for upper eyelid surgery are done with the patient awake with their eyes open, partially closed and fully closed.  The planned skin removal is carefully measured so the eyes can closed.  If the eyes can closed during this measurement, they will be able to close after surgery.  Some patients wish to have their surgery done under local anesthesia as it reduces the cost, but this is not a requirement.  Other patients do not want to be awake during their surgery and still will get an excellent result with a carefully planned upper blepharoplasty.

For an upper eyelid blepharoplasty local anesthesia is not essential. However, if you have a ptosis (eyelid droop secondary to muscle disruption) and are having a levator muscle repair it is almost impossible to get a good result unless local is used.  Good luck, Jane

In our practice, upper eyelid surgery can be performed under local anesthesia, or general anesthesia depending upon the patient's desires. It is not essential that the patient can open and close their eyes to judge the effect of the surgery. The majority of patients in our practice elect to undergo eyelid surgery under general anesthesia for patient safety and comfort. For many before and after results of upper blepharoplasty, please see the link and the video below

no, you do not need to be awake during eyelid surgery. The surgeon will mark you before surgery and will be able to judge the proper steps to perform during the procedure while under anesthesia. A board - certified plastic surgeon will have the proper skill set to perform this procedure safely under anesthesia ,which will be more comfortable for you.

Sometimes, eyelid surgery can be performed under local anesthesia ,especially for the upper lids alone, but more often, anesthesia is provided.

Thanks for the great question. In my opinion, when planned properly, there is no reason for the patient to be away during eyelid surgery. I see my patients the morning of surgery and make my marks then, these are the same marks which are used during the surgery. Some patients prefer to have the surgery done under local anesthesia for cost and the reasons, but by no means does it always have to be performed while the patient is awake. I hope this helps!~Dr. Sieber