Is Ativan alone enough for an upper blepharoplasty?

Question

Hi. When I inquired about anaesthesia and medication they said all they do is give you a sublingual Ativan before the upper bleph surgery. He does not use a laser just a scalpel. Is this a major red flag?!!!! Thx.

Anna Petropoulos, MD, FRCS · Answer

Dear 2014Anna,
Thank you for your question. It is very common for Plastic and Facial Plastic Surgeons to perform Blepharoplasty under local infiltration  of lidocaine, often with an Ativan pill by mouth. For patients who wish additional relaxation, we may add iv sedation  in the settings of a properly accredited facility. Use of a laser does not improve results and actually may not be as efficient with hemostasis as a standard needletip Bovie electrocautery. More importantly the results are related to the skill and experience of the surgeon and to their Board Certification in Plastic, Occuloplastic, or Facial Plastic Surgery. I hope this was helpful !

Best wishes in your quest for a successful Blepharoplasty,

Sincerely, 
Dr. Anna Petropoulos
Board Certified Facial Plastic Surgeon
Boston's North Shore

Kenneth D. Steinsapir, MD · Answer

There laser is a gimmick that is implied to be better for surgery than a scalpel but it is not true. The laser is actually a very crude cutting instrument that burns the skin and interferes with its ability to heal. The skin does not heal rapidly after being cut by a laser and stitches need to be left in much longer leading to suboptimal wound healing. In contrast, when a scalpel is use, there is no thermal injury to the skin. The wound heals much faster and stitches can be removed as early as 5 days after surgery. Now regarding doing surgery under ativan, it can be done but it is rough. Intravenous sedation is much more comfortable. It is more expensive to perform surgery under intravenous sedation because it is administered by an anesthesiologist or anesthetist. In order to do this, most localities require the surgery center where these drugs are used to be accredited. That is significant for patient safety. Accreditation for surgery centers regulates their governance and almost every aspect of the safe operation of the surgery center all to the benefit of the patient. Yes it is a more expensive operating environment than an unaccredited back office procedure room. I do a very detailed eyelid surgery. I my patients are lightly sedated during surgery so they can cooperate but if needed additional medication can be provided if needed. In addition, I have a circulating registered nurse in the operating room and a certified surgical technician who is assisting me with surgery. Ask the surgeon who wants to give ativan who accredits their operating room.  It does not mean they can't do your surgery in their back office procedure room but a lot of patient safety corners are getting cut. You can decide for yourself if you are  comfortable with that style of practice.

Mehryar (Ray) Taban, MD, FACS · Answer

Upper blepharoplasty can easily and effectively and safely be performed under local anesthesia as you will see in video. The method used for incision is mainly surgeon's preference.

William Portuese, MD · Answer

An upper blepharoplasty procedure can certainly be performed under local anesthesia with or without oral sedation.  Some patients also elect to have the procedure performed under general anesthesia. In our practice, we use a scalpel, and never use the laser around the eyes

Robert L. Kraft, MD, FACS · Answer

Upper lid blepharoplasty is a procedure I perform with local plus oral sedation. It’s a quick operation and the cost of an anesthesiologist is absurd. Also it is performed via scalpel to have the greatest control. There is no need whatsoever for a laser!
Hope this allays your concerns. Best wishes.

Scott L. Replogle, MD (retired) · Answer

I have done both upper and lower lid blepharoplasty with local anesthesia and oral sedation alone for years. The key is good local anesthesia but some patients just can't handle any procedure even with good local anesthesia and the next alternative would be IV sedation with monitoring. Since you can't realistically switch from oral sedation to IV sedation during the procedure, what the patient can handle and signs up for is determined before the procedure.

Robert T. Buchanan, MD (retired) · Answer

Neither of these things you mention are "red flags." In fact, most good surgeons I know do all their upper blepharoplasties when not doing other procedures at the same time under local anesthesia. They and I use an anxiolytic like Atavan for those who are very anxious about the procedure. Most of the time, however, the patient gets nothing. I learned laser surgery from one of the physicians who developed it. When used properly, it does the same thing that a scalpel or electrosurgical instrument using a needle tip does, but is much more bulky, harder to use, and more expensive. For these reasons, I gave up the laser many years ago. I do not know where you got your information, but the surgeon you saw is definitely among the vast majority.

Is Ativan alone enough for an upper blepharoplasty?

Answers (7)

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