Is it advisable to undergo bilateral ptosis surgery under general anesthesia?

Question

I am having surgery soon and my doctor recommended going under general anesthesia since my insurance is covering procedure and I might be a little nervous. I've been under once before for a different surgery but it makes me nervous....is general anesthesia overkill for such a procedure?

John J. Martin, Jr., MD · Answer

It can be done with either local or local sedation.  Depending on the procedure performed, the surgeon may want you to open your eyes to check the lid height. Putting the anesthetic into the eyelid can burn a little but after that you should have no pain.

Kenneth D. Steinsapir, MD · Answer

Any surgeon who would recommend that ptosis surgery be performed under general anesthesia, with the exception of very rare situations for adults, does not know what they are doing.  It is critical to be able to have the patient cooperate during the actual surgery with the opening and closing of the eyelids.  The surgery is actually adjusted based on this movement.  This can only be done on an awake patient.  Intravenous sedation is very good for this and profoundly reduces anxiety.  You may not even remember the surgery.  However under general anesthesia, there is no cooperation.  Surgery cannot be accurately performed.  If this is what your potential surgeon has recommended, I am sorry, you are in the wrong office.  In the Bay Area, consider seeing Drs. Rona Silkiss or Stuart Seiff for oculoplastic surgery.  Both are very experienced and highly regarded .You don't want ptosis surgery performed under general anesthesia!

Mehryar (Ray) Taban, MD, FACS · Answer

99% of eyelid ptosis procedures are done under local anesthesia (with or without sedation) since the best result can be achieved when the patient opens/closes his/her eyes during the procedures for optimal eyelid lift. The patient is comfortable and numb during the procedure. The only cases that are done under general anesthesia are uncooperative patients, such as kids. So general anesthesia is overkill for such procedure. See an oculoplastic surgeon.

Kenneth Bermudez, MD, FACS · Answer

General anesthesia is very safe. Improved medications, monitoring and techniques have made it safer than driving your car. Especially here in San Francisco!If you are healthy, without major medical problems, your risk is minimal and comparable to a deep sedative.My suggestions is to discuss your options and concerns with the anesthesiologist before your surgery. It will put you at ease and allow you to make better decisions about your care.Best of luck.

Emily J. Kirby, MD · Answer

This surgery is performed regularly using local anesthesia, IV sedation anesthesia or general anesthesia.  If your surgeon recommended general anesthesia, that is likely your best option.  He/she knows you better than anyone in this forum!  It also means that your surgeon prefers that anesthesia for your specific surgery.

Chase Lay, MD · Answer

generally I perform this under local anesthesia or IV sedation.  If you're having a procedure referred to as a Putterman procedure where there are no external incisions then general anesthesia might be okay.  However, ptosis surgery usually requires some participation on the patient's part.  For this reason I think general anesthesia may not be a great idea because I would be due to open her eyes and look up as we are performing the surgery.I'll attach a video about ptosis surgeryChase Lay, MDDouble board certified facial plastic surgeon

Kimberly Lee, MD · Answer

Usually, ptosis repair can be performed under local anesthesia or under IV sedation where a little bit of sedation is given to make it more comfortable for the patient.  It depends on your comfort level and how nervous you get.  Please consult with your board certified specialist who can assist you with achieving the results you seek.

Stephen Weber MD, FACS · Answer

Anxiety can be well controlled with IV sedation in the operating room. The biggest issue with general anesthesia during ptosis repair is the inability for you to voluntarily open and close your eyes to ensure the best possible result for you. I hope this information is helpful.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

Matheson A. Harris, MD · Answer

The risks of general anesthesia are much less today than in the past. That being said, there are less serious risks of nausea and general discomfort for hours to days after surgery with general anesthesia.  Most people undergo ptosis surgery with sedation and IV pain medicine. When local anesthetic is injected, the anesthesiologist can have to fall asleep for a few minutes so you are unaware of the injection. You might discuss this option with your doctor, but if he feels general is the way to go, it is an appropriate course.

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question.  Of course it is important to follow the advice of the physician that you have trust and plan to have surgery with.Often surgeons choose to do ptosis surgery with the patient awake under local anesthesia.  Positioning of the eyelid during ptosis surgery is crucial and 1 mm can often make the difference between a good and not so good result.With local anesthesia of the surgeon And ask you to open and close your eyes and get a more accurate approximation of the ptosis correction.

Is it advisable to undergo bilateral ptosis surgery under general anesthesia?

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