Straight Local for Lower Eyelid? (photo)

I am scheduled for lower eyelid surgery on May 23. Pics attached. My PS advised that the op will be performed under local + oral sedation as he needs my co operation during the surgery for the best result. Could somebody advise whether i will feel much intraoperative pain? My doc said there will be no pain; however most of PS here recommends general or IV sedation for bag surgery. Also judging by my pics, is lower bleph surgery an optimal procedure for my horrible bags? Appreciate your help

Doctor Answers 6

Anesthesia for lower eyelid surgery

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First of all, it does appear that you would benefit from lower eyelid surgery to improve the bags under your eyes.  In regards to the anesthesia, there is no right or wrong answer.  It really is just a matter a preference between the patient and surgeon.  Personally, I do prefer to perform the procedure with IV sedation.  It is still possible to have the patient cooperate, when needed, with this type of anesthesia.  It is possible to have the procedure with just local anesthesia and oral sedation though.  You most likely would have some pain at the beginning of the procedure when your eyelid area would need to be injected with the local anesthetic, but then should not feel anything afterwards.    

San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

Lower Eyelid Blepharoplasty under local anesthesia

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I have a very large series of patients who have undergone lower eyelid blepharoplasty in my office under local anesthesia and feel that this is a safe and well tolerated procedure.  No problems with your surgeon's choice. Good Luck. Raffy Karamanoukian, Los Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Using local anesthesia depends on the comfort level of both the surgeon and the patient. I personally prefer local anesthesia

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Lower eyelid puffy bags are referred to as herniated fat. This means that the fat that is normally around your eyes has pushed forward and herniated, causing you to have eyebags.

The use of anesthesia has a lot to do with the surgeon’s comfort level. Many years ago, I almost exclusively performed these procedures under local anesthesia. Local anesthesia uses no intravenous sedation but simply injecting anesthesia under the skin of the area we need to operate on with the patient being wide awake. A lot of my colleagues, especially in the plastic surgery community, felt that I was being aggressive and there was a safety concern about working around the eye without the patient under general anesthesia. Being an oculofacial plastic surgeon and being trained in this area very extensively, I was comfortable doing the surgery in this way. I knew how to time the anesthetic application that was appropriate for my patients.

Over the years, I learned that some people tend to need more than local anesthesia. Typically in my practice, I do local anesthesia with IV sedation. IV sedation consists of liquid valium or Propofol where we use enough sedation or medication that allows you not to be aware of the procedure but if we wanted your cooperation, we can wake you up. This type of sedation is my preferred approach these days and we’ve been doing that for years. Consistently, our patients have been very happy.  I hope that was helpful to you, and thank you for your question.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Straight Local for Lower Eyelid?

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        The injections of local anesthetic will hurt initially.  If the fat compartments are then injected before removal of the fat, this is a relatively painless procedure.  However, I usually perform these under general, because a moving patient is not helpful.  Find a plastic surgeon with ELITE credentials who performs hundreds of eyelid surgeries each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

Straight Local for Lower Eyelid?

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 I have performed Eyelid Surgery for over 25 years and while a lower Blepharoplasty can be done with straight local injections...I do not agree that you won't feel anything.

 At the very least you will feel pressure and heat from the electrocautery used to coagulate the fat which contains blood vessels.  You will most likely feel the injections of the local anesthetic.  If the lower Bleph is performed, as in my opinion it should, transconjunctivally or through the will feel claustrophobic with eye shields or uncomfortable at the sight of instruments and retractors being placed inside your lower eylids.  

 I have done this procedure on a few occassions under straight local but the partients understood and were OK with the above as described.  I do not believe this is for everyone.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Lower lids under local?

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While it is possible for this procedure to be done under local, my preference in males is to have them asleep or heavily sedated since women are better able to tolerate discomfort.  I'm not sure why you need to be awake for a lower lid procedure and perhaps your surgeon can explain why you need to be awake for this.  Bottom line, you must stay still during the procedure... can you do that?

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 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.