Can Eyelid Surgery Be Done Without Anesthesia?

Can bleph eyelid surgery be done without anesthesia?  If so, how does it work?

Doctor Answers 73

Local anesthesia preferred for blepharoplasty

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Upper eyelid blepharoplasty can be safely performed under local anesthesia in most patients. The preoperative workup of a patient for blepharoplasty is important in assessing the anesthetic and surgical risks of a patient. Your surgeon should be qualified in the surgical and perioperative managment of patients undergoing surgery.

Upper eyelid blepharoplasty can be performed under general anesthesia and conscious sedation, however, local anesthesia with or without an anxiolytic is preferred.

Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Blepharoplasty with valium and lidocaine

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I have a plastic surgeon who does these in my office and uses 5 mg of valium and local anesthesia. His patients are very pleased and are driven home by a friend or spouse. I have watched him do this in many patients and I don't perceive them to have any discomfort whatsoever! Dr. Raffy Karamanoukian (disclosure - my brother) also does these in his offices. I think it is well tolerated.

As a heart surgeon myself, I have done coronary bypass surgery on a dozen people who had eyelid surgery under general anesthesia and approximately a week later they had suffered a heart attack - it is related to the eyelid surgery in that any kind of general anesthesia risks coronary ischemia if there is undiagnosed coronary artery disease.

I therefore recommend that whether a blepharoplasty is being done under local or general anesthesia, that the doctor doing it screens you for possible heart problems by asking you some simple questions that are directed toward that.

Blepharoplasty is easily done without general anesthesia

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I assume you mean general anesthesia.  Blepharoplasty in my hands is almost exclusively done under local anesthesia or local anesthesia with slight sedation.  Attached is a video showing the procedure.

Raghu Athre, MD
Houston Facial Plastic Surgeon
4.6 out of 5 stars 94 reviews

Choosing anesthesia for eyelid surgery

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Eyelid surgery without any form of anesthesia would be cruel and unusual punishment. But I'm sure you are asking if eyelid surgery can be done without general anesthesia. And the answer is a definite yes. In fact, nearly everything that plastic surgeons do can be done without general anesthesia.

Your choices for eyelid surgery are three: Local, Local with sedation, and general anesthesia. With local anesthesia you will feel the injections of the anesthetic and may have moments of pain during surgery which will prompt your surgeon to inject more local to give you relief. With sedation and local the same is true only you will not remember the experience at all. Sedation makes surgery a lot more comfortable without placing a tube in your throat and helping you breathe.

When having surgery under general anesthesia you will have absolutely no pain during surgery and have no memory of the entire process. It is the most comfortable option, though probably takes the longest to wake up from after surgery. The risks and benefits of these choices are debatable and should be discussed with your anesthesiologist. If you have a strong preference for any of the above choices, your surgeon should be able to accommodate your wishes.

I hope this info helps!

Adam Rubinstein, MD
Miami Plastic Surgeon
4.9 out of 5 stars 21 reviews

Eyelid surgery without anesthesia would be intolerably painful

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Eyelid surgery or for that matter any surgery would be too painful to perform without any anesthesia. I suspect that you meant to ask whether eyelid surgery could be performed while you are completely awake under a local anesthetic alone. This would be comparable to having a cavity filled by your dentist with an injection of the local anesthetic in your gum.

In the case of blephroplasty or eyelid surgery, local anesthetic alone would suffice but I wouldn't recommend it. Patients undergoing eyelid surgery while completely lucid can't help but have an increase in their blood pressure because they are understandably nervous. This increase in blood pressure causes an increase in bleeding that clouds the operative field and makes the surgery more difficult.

I find that for eyelid surgery, the patient must be made unaware of the goings on and this implies the need for either intravenous sedation or general anesthesia. Think of how you might react to seeing the scalpel come near your eyes and you will understand my point.

David A. Ross, MD (retired)
Chicago Plastic Surgeon

Local anesthesia is my routine for eyelid surgery

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Local anesthesia is my general routine for blepharoplasty. The local anesthesia injections in the eyelids are not painless, but relatively low pain. Some patients desire a little oral or IV sedation which is always a possibility.

York Jay Yates, MD
Salt Lake City Plastic Surgeon
4.9 out of 5 stars 189 reviews

Eyelid surgery can be performed without general anesthesia.

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Eyelid surgery can be performed without general anesthesia. It is reasonable to undergo upper eyelid blepharoplasty under straight local anesthesia. One can also perform some types of lower lid blepharoplasty procedures under local anesthesia as well. For some more aggressive procedures, patients will benefit from some sort of sedation or general anesthesia.

Sanjay Grover, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 245 reviews

It could - but you wouldn't want it

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Some form of anesthesia is needed to do any kind of surgery. There are generally three levels of anesthesia - local, sedation, and general. Local is similar to what most dentists will administer. It involves injecting numbing medicine at the area to be operated on. Sedation involves some sort of medication which alters a person's state of consciousness. In general sedation will not require a breathing tube and is fairly easy to rebound from. General anesthesia is what is thought about for most surgeries. In this type of anesthesia, the patient is completely asleep, requires a breathing tube and can take a day or two to recover.

Eyelid surgery can be done with any of the three types of anesthesia. Upper eyelid surgery is probably most commonly done using local anesthesia though there are circumstances where sedation or even general is necessary. Lower eyelid surgery is a bit more complicated. There is usually more involved with lower eyelid surgery than upper eyelid surgery and there is probably an even split to be able to perform the surgery using local, sedation, or general anesthesia. There is no answer for every situation and consultation with your surgeon, specifically expressing your wishes for the type of anesthesia are very important.

Hope this help.

D.J. Verret, MD
Dallas Facial Plastic Surgeon

Don't pass on the local anesthesia!

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Hi Carole,

Upper and lower eyelid surgery is usually performed in my office under anesthesia. Local anesthesia with "adrenaline" is injected just under the skin about 5 to 10 minutes prior to the treatment. The only exception is if there is excessive fat pad protrusion in the lower lids, then I prefer having the patient under sedation anesthesia. Choose your surgeon carefully. Good luck.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

Eyelid Surgery without General Anesthesia

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Certain types of eyelid rejuvination can be done with only local anesthesia. More complex and deeper procedures involving fat or muscle work require sedation or general anesthesia. Local anesthesia is given with an injection (usually Lidocaine). No surgery on the body can be done without at least local anesthesia.

Upper and lower eyelid blepharoplasty where only skin needs to be removed can be done under local.

Look in the mirror and see if your upper eyelid skin appears to be excessive. Then note if your eyebrows have fallen significantly. Next look at the upper eyelid area below your eyebrow and to the side of your upper nose. See if that region looks puffy. If your eyebrows are still high and you don't have puffiness next to the nose, then a skin only procedure may be right for you.

For the lower eyelids, look to see if there is significant puffiness betwen the eyelid and the cheek. Look to see if your eyelid is tight against your eye and snaps back quickly after you pull it away from the eyeball. Look for wrinkling in the skin. If you only have wrinkled skin and your eyelid snaps back quickly, then a skin only lower eyelid procedure (skin pinch) may be the appropriate procedure for you.

Keep in mind that the eyelid region is very sensitive. Some patients (5-15%) are resistant to the effects of local anesthetics. You have to be a little tough to have a local-only eyelid procedure. Usually, I ask my patients if they are OK at the dentist. If they say yes, then local facial plastic procedures usually go well.

Richard W. Westreich, MD
Manhattan Facial Plastic Surgeon
4.9 out of 5 stars 55 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.