Pain During Cosmetic Eye Surgery Despite Sedation?

Is there a chance you feel pain with I.V. sedation in eye cosmetic surgery? I'm considering a Brow lift and lower Blepharoplasty, but I'm worried that I will feel some pain during the procedure.

Doctor Answers 13

Make sure your've got an Anesthesiologist

Sedation and local can be fine foreyelid surgery, but youhave to make sure it's being done right. You should have a board certified anestheioslogist doing the anesthesia. An operating rooom is preferable, but an office OR is OK if their is an anesthesiologist. Don't accept shortcuts or you'll be taking unnecessary risks.

Boston Plastic Surgeon
3.2 out of 5 stars 7 reviews

Intravenous sedation and pain

If the IV sedation is light, it is quite possible the patient will experience a small amount of pain during the surgery, usually during the injections of local anesthetic, and during manipulation of the fat in the upper eyelid.

If the anesthetic is deeper, such as that performed by an anesthesiologist, the patient will be extremely unlikely to experience pain of any kind.

Patients who are very concerned about pain or anxiety during their surgery should consider having sedation performed by an anesthesiologist.during their surgery.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 177 reviews

Fat removal from the eyes can be painful

The eyelid surgery is generally well tolerated but some extra local anesthesia is usually needed if there is fat to remove.  The gentle pulling on the fat can irritate nerves deeper down than the original local covered.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

General anesthesia is preferred

Cosmetic eyelid surgery is painful when the fat is removed from the eyelids. The lower lid happens to be more painful than the upper lid because of the more extensive fat removal. The patient’s safety and comfort is best when the patients are put to sleep briefly under general anesthetic to have this surgery performed. Patients will not remember and feel pain when the fat is removed. The fat does not respond to the local numbing medication.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Well done anesthesia should leave you completely comfortable

Lana in NoCal:

In my practice I have used a variety of methods for carefully selected patients, from local only (rare), to mild sedation plus local, to light general anesthesia. In my current situation we use general anesthesia for most patients (bear in mind that many patients are having combined procedures, such as facelift, etc.).

It is certainly reasonable to expect to be completely comfortable with sedation and local anesthesia. Each surgeon and anesthesia provider (nurse anesthetist or MD anesthesiologist) may use different techniques and you should question them, express your concerns, etc prior to surgery.

Sutton Graham II, MD
Greenville Plastic Surgeon
4.8 out of 5 stars 5 reviews

With good anesthesia, should not feel any pain

There are different options for anesthesia during cosmetic eyelid or brow surgery, but in general there is no reason to feel any pain. The procedures are usually done with either IV sedation or general anesthesia, and eyelid surgery can at times be done with the patient awake and with local anesthetic only.

Speak with your surgeon about his plan, but there is little to no risk of pain during the procedure with proper IV sedation or a general anesthetic.

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
4.9 out of 5 stars 149 reviews

Good anesthesia trumps pain in eyelid surgery

Under most circumstances a patient under IV sedation will not recollect any pain for eyelid surgery. That said, every person's threshold for good IV sedation differs and that is why a dedicated person administrating the sedation is best. The dept of sedation will determine the perception of pain one realizes. Good local anesthesia, especially when manipulating the medial fat pads will minimize the amount of IV sedation required. Overall, eyelid surgery is tolerated well even by the most anxious of patients.

Lee Kleiman, MD
Annapolis Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

There is no reason to feel pain.

There are several ways of providing anesthesia for Browlift and Blepharoplasty. The one you mention works very well. Even then, there are options. Once the areas are anesthetized, you will feel only movement, pressure and wet/cold. You may feel the injection to the nerve under the eye and the several nerves just above rim of the orbital bone that establishes the anesthesia, however. If someone like an anesthesiologist is monitoring you, they can give you an IV medication that essentially makes it where you do not even feel this. In either case, the medication used to sedate you generally makes you forget anything about the procedure. Most people awake at the end of the procedure wondering when it will begin.

The other option for these procedures, and my personal favorite, is a light general anesthesia. Instead of using IV medications for sedation, an agent that you breathe in is used. This is increased while the local anesthesia is injected and then reduced for the rest of the case. Since you do not need it for surgical anesthesia (the local does this), it is used merely to keep you comfortable. At the conclusion of the case when the anesthesiologist turns off the gas, you awaken immediately. This is because there are almost no IV drugs used that have to be metabolized in the liver before their effects are gone. Once the gas is off, you breathe out any residual gas and its effect is gone. The other advantage is a marked reduction in postoperative nausea. We almost never see any nausea, even where I am in the mountains with curvy roads to travel home post operatively. Also, with this method, you feel absolutely nothing. Because of these advantages, and the safety of the method, I have switched entirely to light general anesthesia supplemented with local injection. To use it, however, one needs to work in a facility certified for general anesthesia. Most non-certified practitioners who do not have hospital privileges in Plastic Surgery or work in a certified operative facility will not, therefore, be able to utilize this method.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 6 reviews

General Anesthesia is your only guarantee for no pain

Although both procedures are generally well tolerated under local anesthesia with sedation, general anesthesia is the only way to guarantee no pain.  Surgeon preference generally dictates which type of anesthesia is used, but you should talk to your surgeon about your concerns.

Kevin Ende, MD
Manhattan Facial Plastic Surgeon
4.6 out of 5 stars 10 reviews

Shouldn't but...

With eye surgery it's easy enough to have the patient sleep while the lids are injected with local anesthetic. However, the brows require a much larger areas of coverage. With that said as long as your plastic surgeon blocks all of the appropriate nerves with a combination of short and long acting agents there shouldn't be a problem.

Christopher L. Hess, MD
Fairfax Plastic Surgeon
4.4 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.