I am considering lower eyelid blepharoplasty. I have concerns about the anesthesia options.

I do not tolerate anesthesia well. When I had da Vinci surgery, it went great--except for PONV. The CRNA was proactive with preop meds (phenergan, scopolamine) and post (Zofran). No luck (she used propofol, no gas). With the eyelid surgery, I'm happy to have a local anesthetic and Valium, which worked fine for a dental surgery. (Versed causes me breathing issues). Is that sufficient to keep my surgeon (and me) comfortable? I'm worried about nausea, not the surgery. Thanks!!

Doctor Answers 14

Lower Blepharoplasty under local anesthesia

Thanks for the question.  I routinely do lower blepharoplasties under local anesthesia and this can be done safely and effectively.  This involves a block of the nerves the provide sensation the lower eyelids (infraorbital nerve) and topical anesthetic eyedrops in the eyes.  The use of corneal eye shields also makes the procedure more tolerable.  Patients are given 1 mg of Xanax before the procedure and placed on a monitor during the procedure.  As far as the nausea, this may be related to the use of narcotics or the anesthesia in the past.  I would recommend limiting the use of narcotics postoperatively and only taking the narcotics with food to avoid the nausea.  You may also want to consider taking Emend before the procedure.  This is an anti-nausea drug that works great in preventing post-procedure nausea.  It is kind of pricey but very effective when taken about an hour before the procedure.  Good luck.

Local anesthesia

Most blepharoplasties(eyelid surgeries) can definitely be done under local anesthesia. It more so depends on the comfort level of the patient and how much work is actually involved. Valium and/or sedation are also an option, as well as pre and post operative anti-nausea medications.

Clayton L. Moliver, MD
Houston Plastic Surgeon
4.5 out of 5 stars 27 reviews

Eyelid surgery okay under local anesthesia

Most eyelid surgeries can certainly be done under local anesthesia with oral valium. See following video and link for examples. See an oculoplastic surgeon who is comfortable with the anesthesia type.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 58 reviews

I am considering lower eyelid blepharoplasty. I have concerns about the anesthesia options.

For a low lid blepharoplasty, my most common anesthetic option is local anesthesia. If this is probably done, it was going on there should be minimal discomfort if any at all. I use a general anesthetic if a patient prefers or if it is done simultaneously with a facelift and other procedures. Either local anesthesia with mild PO sedation or a general anesthetic should work very well for you. Good luck, and I'm sure your procedure will turn out well.

Local anesthesia for lower blepharoplasty

Lower blepharoplasty can very safely and comfortably be performed with local anesthesia only. I utilize a transconjunctival approach for fat repositioning, and I now perform almost all of those procedures with local anesthesia and maybe some light oral sedation. 

This process was an evolution, my training was very progressive and cutting edge, but even there many of our lower blepharoplasties were performed with general anesthesia or IV sedation. After getting more and more comfortable with the procedure and realizing that it could be easily performed without those higher levels of anesthesia, my practice evolved and patients are thrilled with the ease of recovery and results of the procedure.

This is definitely not something that everybody does, but if you can find a modern and highly trained surgeon, it should be something they can easily do. I lecture to my peers about this exact topic of performing these lower blepharoplasty procedures with local anesthesia only.

To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties.

Cameron Chesnut
#realself500 Physician

Cameron Chesnut, MD, FAAD, FACMS
Spokane Dermatologic Surgeon
4.9 out of 5 stars 62 reviews

Sedation for Lower Blepharoplasty

A lower lid blepharoplasty under local anesthesia is technically feasible, depending on the patient.  Most of us will have patients, who from time to time, will prefer not to have sedation.  However, this represents the minority of cases I encounter. Postoperative nausea vomiting (PONV) is most commonly seen with opioids or inhalational gases and very rare with propofol.  In fact, propofol and steroid combination can have a mild ant-emetic effect.  Another anti-emetic you can ask your Surgeon about is Emend, which I utilize for patients with a history of nausea. Good luck with your procedure!

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 81 reviews

Anesthesia go Blepharoplasty


Lower eyelid blepharoplasty can be performed under local anesthesia. If you have a strong history of post operative nausea and vomitting this may be the best option for you. An oral sedative/anxiolytic can be given before to reduce anxiety. Providing effective local anesthesia is important with this procedure. Make sure your surgeon is comfortable with this technique. 


J. Phillip Garcia, MD, FACS
Jacksonville Facial Plastic Surgeon
4.7 out of 5 stars 31 reviews

Anesthesia for Blepharoplasty

Thank you for sharing your concerns.  I'm sorry to hear that you had a difficult experience with anesthesia in the past.  Lower eyelid blepharoplasty can be performed under local anesthesia, but most patients find it to be more comfortable to have some sedation.  These concerns are best discussed with your surgeon and the anesthesia staff prior to surgery.  Make sure that they have a copy of your anesthesia records from your previous surgery so that they know what did or did not work for you.  Good luck!

Samuel Baharestani, MD
Long Island Oculoplastic Surgeon
4.8 out of 5 stars 21 reviews

Lower Blepharoplasty under local

Lower Blepharoplasty can definitely be performed under local anesthesia. Consult with an experienced and expert board certified plastic surgeon to understand your options. 

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 36 reviews

Lower Bleph under Local

Yes the lower eyelid can be adressed under local anesthesia depending on the patient. If you are nervous, oral or IV valium can help to keep the edge off. The most important thing is to stay calm and keep your blood pressure low.

Brian Maloney, MD, FACS
Atlanta Facial Plastic Surgeon
4.6 out of 5 stars 25 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.