Lower Blepharoplasty while awake?

Question

After a recent consult for upper & lower blepharoplasty, I was ready to go, until I was told I'd be awake through the procedure in the office operating suite. Is this standard procedure? I had expected to be anesthetized and can't imagine having my eyes operated on while I'm awake, afraid I might have a panic attack during surgery. Having the procedure at a local hospital is an option, however the cost increases $3K and not in my budget. Any help to allay my fears is appreciated. Thank you, Dee

John J. Martin, Jr., MD · Answer

I think that upper lids can be done easily with local anesthesia.  For lowers we use IV sedation.  Even with the local anesthesia, patients are usually not comfortable with the manipulation of the fat.  Xanax or ativan pre-op can help, but still can be tough for some people.  When a patient is uncomfortable it makes it difficult to perform the surgery.  So much better for both the surgeon and the patient if some sedation is used.  I agree that 3K seems a bit steep for the OR fee.

David S. Felder, MD · Answer

Debra,We perform many upper eyelid blephs in the office only using local anesthesia. However, lower eyelid blephs in our office are performed with IV sedation. It is much more comfortable for the patient and is a relatively short procedure. The $3000 increase in cost seems excessive.

Mehryar (Ray) Taban, MD, FACS · Answer

Lower blepharoplasty can certainly be done under local anesthesia along with oral sedation (xanax or valium) as long as the surgeon and patient are comfortable with it. See video below for such example. See link below too.

Amir Nakhdjevani, MBBS, MRCS, FRCS(Plast) · Answer

Thank you for your question Debra.  Lower Blepharoplasty can be performed under local anaesthetic, I would stay 50% of my patients will opt for this when I advise.  Lower Blepharoplasty under local anaesthetic however can be sensitive if the fat pockets are particularly bad, therefore having to go deeper under local anaesthetic can be too uncomfortable for some patients.I always advise my patients, if the lower fat pockets are not very bad than local anaesthetic is a perfectly fine option, however due to some discomfort which may be cause, this could mean that instead of achieving a result with 100% removal of fat etc, only 70-80% could be achieved.  Patients will then have to weigh up the benefits of the results, discomfort and the finance cost (financial costing more under general anaesthetic and may be a health risk to some patients).  Debra, another option would be twilight sedation meaning you will be unaware of the procedure however again less health risks and costing less.Best Wishes with your procedure, I hope you get a great results!

Frank P. Fechner, MD · Answer

At the end, anesthesia choice depends on doctor comfort and patient choice. It certainly is possible to perform a 4-lid blepharoplasty using local anesthesia only (and I have done so many times at patient's request). Personally, our routine for eyelid procedures is sedation performed in our accredited surgical center.We never use general anesthesia for blepharoplasty.

Lower Blepharoplasty while awake?

Answers (10)