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

According to what I read a person has to be awake to open and close the eyes as it is essential that the patient can open and close the eyes to judge the effect of the surgery. (Keep awake with a local anesthesia) Is open and closing the eyes necessary for the upper eyelid surgery?

Doctor Answers 12

Awake or asleep for 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. 

Dallas Plastic Surgeon
5.0 out of 5 stars 89 reviews

Anesthesia for Upper Eyelid Surgery

This question is hard to answer since I do not know what procedure you are talking about. If you are asking about a cosmetic blepharoplasty, this can be done gust as well awake or asleep as long as the markings are placed before surgery with you awake and cooperating. If, however, you are talking about a ptosis procedure, there some of these that are best done under local anesthesia to make sure the 2 eyelids are made even. Others, however, can be done asleep, again with proper preoperative preparation. Make sure whoever you see has significant experience in the procedure you need.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 5 reviews

If you are a surgeon accustom to operating on sleeping patients, you believe that it is okay to have the patient sleeping.

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.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

Awake 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

Andrew Campbell, MD
Milwaukee Facial Plastic Surgeon
4.7 out of 5 stars 26 reviews


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.


Dr. J

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 85 reviews

Type of anesthesia for eyelid surgery

Patient preference plays a role in the level of sedation or anesthesia for eyelid surgery. Measurements obtained at the time of consultation are important guidelines for surgery. It the diagnosis is ptosis rather than dermatochalasis, the level of sedation becomes more important. Ideally, the levator attachment, lid margin contour, and symmetry are adjusted intra-operatively with the patient awake. Clearly this is not possible with children and some young patients. Deep sedation or anesthesia makes the intra-operative decisions and judgment more difficult and introduces a small risk of needing touch-up surgery if the contour, level and symmetry are not perfected. Best wishes.

Sara A. Kaltreider, MD
Charlottesville Oculoplastic Surgeon
5.0 out of 5 stars 3 reviews

It is not necessary to be awake.

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.

James Shire, MD
Chattanooga Facial Plastic Surgeon
5.0 out of 5 stars 9 reviews

Awake for upper eyelid surgery?

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

William Portuese, MD
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 126 reviews

Being awake for upper eyelid surgery is not necessary.

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.

Upper eyelids

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

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.