Upper blepharoplasty surgical ethics

Is it ethical or normal for a surgeon to enter the procedure room with patient lying down and inject, mark, and then cut immediately (in that order) never sitting patient up or measuring?

Doctor Answers 6

Blepharoplasty ethics

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All of us have different ways of approaching the procedure, and the patient.  I prefer to see and speak with someone (sitting up) just before a surgical procedure to make sure we both have the same expectations and plan.  I also mark patients for blepharoplasty in a sitting position, but have known good surgeons who prefer to do marking with the patient already resting comfortably on the bed.  No matter the technique, I hope you have had a wonderful result from your procedure!

Sounds normal

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This is not a question of ethics, but rather surgical preference. Surgeons have different techniques which work best in their hands. The lid crease is visible before and after the injection, lying down or sitting up, and can be marked before or after the injection. If the lid crease is visible to the surgeon, it does not necessarily have to be marked. The excess can be determined lying down or sitting up. My preference is to have my patient lying down, inject, prep, mark after 5-10 minutes when the anesthetic has settled and the prep is dry, then proceed. Discussion during the consultation should give you information that you feel is important prior to entering the operating room. Hope you experience excellent results. Best wishes.

Sara A. Kaltreider, MD
Charlottesville Oculoplastic Surgeon
5.0 out of 5 stars 12 reviews


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Each surgeon is different in how they mark, measure, and proceed. No one way is the "right" way to do it.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

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Upper lid blepharoplasty - surgical ethics?

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Thank you for asking about your upper lid surgery.
  • It sounds as though you had an unsettling experience during your upper lid lift - I am sorry about that.
  • Every surgeon does things differently.
  • My approach is to measure and mark my patients sitting, show them the marks and get their approval -
  • Sometimes patients see things I don't, and vice versa so I like the team approach.
  • Then, once the patient is lying down, I may re-measure and adjust the marks. 
  • Then I inject and then I do the surgery.
  • Most plastic surgeons will not inject before marking - because the injection distorts the anatomy.
  • I hope you had a good result - even if your surgeon's approach unsettled you.
Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Upper eye bleph

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That is how most surgeons would do it.  It is not easy to mark someone in the sitting position.  We lie them down, and then mark the lid crease.  Excess skin is usually determined using an instrument which grabs the extra skin and this is then marked.  An injection of local anesthetic is then given.  And when ready the surgery begins.There is no advantage to sitting the patient up to mark.  

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 31 reviews

Ethical surgical practice

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Ethical? why is it not? did you have a consultation with the surgeon ahead of time and go over the procedure? each surgeon has his or her own routine and they do what works for them. If you have a problem with your results because you have significant asymmetry or develop complications then you can discuss with your surgeon weather the surgical set up impacted the results. Otherwise, that is how the surgeon you selected for your elective cosmetic procedure chooses to perform that procedure.

Edwin Ishoo, MD
Cambridge Facial Plastic Surgeon

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.