How Painful is Eyelid Surgery?

Physical Discomfort During and After Eyelid Surgery

The pain experienced during  an eyelid surgery is usually tolerable and most frequently in my practice the procedure is done with oral sedation or IV sedation with local anesthesia. Although always an option we do not routinely use a general anesthetic. Postoperatively there is  Initial mild discomfort  controlled with oral medications. Swelling, discoloration, and some bruising are to be expected. It is not unusual to have some difficulty seeing during the first day or two after surgery because of the swelling and eye lubricants/ointment used during and after surgery.

The eyelid surgery itself is quite painful during the procedure, and therefore is done under a general anesthetic. The fat pads on the upper and lower lids have deep proprioceptive pain fibers that will not numb up to the lidocaine and should not be done under a local anesthesia. The recovery period for eyelids is not painful at all; most patients only take a very few pain pills in their entire postoperative period.

In my experience, eyelid surgery is one of the least painful of all aesthetic procedures. Most of the discomfort is in the first few days and is more in the realm of itchy or watery eyes which is always relieved by cold compresses and lubricants. Those patients with pre-existing dry eyes may be prone to an exacerbation of symptoms and should have special attention to this.

Of course this is somewhat related to what specifically is done. Some eyelid surgery on the lower lid requires lifting tissue off the bone or putting sutures from the lid tendon to the bone and this can be more painful. Usually, it is quite well tolerated and cold compresses on a frequent time schedule post-op can help mitigate discomfort tremendously. Skin removal only is nearly painless and pain medication requirements are very limited. Most patients do exceedingly well. In fact, symptoms of pain may be related to complications rather than the normal course of recovery.

Dear BHeZee

Eyelid surgery is so comfortable that many of my patients elect to have eyelid surgery in the office under local anesthesia. This is actually ideal because it is very important to have the ability to assess the effects of surgery intraoperatively with the patient sufficiently cooperative to open and close the eyes. When surgery is performed under deep iv sedation or general anesthesia this very important aspect of being able to monitor the effects of surgery intraoperatively goes out the window. Great eyelid surgery is all about finesse. Under general anesthesia this ability to monitor the effects of surgery dynamically is lost. I will not perform eyelid surgery under general anesthesia. These surgeries are surprisingly comfortable. It is not unusual for my patients not to require any narcotics post operatively.

Eyelid surgery can be done under local, IV sedation, or general anesthesia. Well performed anesthesia should make your experience comfortable and pain free. For your upper lids, local is adequate in most instances. The lower lids may be done under local anesthesia, although depending on the extent of the procedure needed, IV sedation is sometimes suggested. General anesthesia is an option, but is usually reserved for more complex issues and/or cases having multiple procedures, such as a facelift.

Post operatively, there should be no intense pain. Most patients describe it as a soreness which is easily managed with oral pain medication.

Eyelid surgery is one of those operations that generally look more painful then it really is. Eyelid surgery is commonly done under local anesthesia. In fact, I do more blepharoplasties under local then under general anesthesia. Pain tolerance is also improved if some form of sedation is given along with the local anesthesia. The sedation can be oral or by IV. The upper lids are particularly well tolerated under local anesthesia. The lower lids generally have much more dissection associated with them and may cause a bit more pain under local.

Post operatively, the pain is generally well tolerated with oral pain medications, however, it will look like you have been in a terrible accident. Again, it looks worse than it feels. I hope this was helpful.

Eyelid surgery (blepharoplasty) involving either the upper or lower lids is a relatively easy procedure from which to recover. Most surgeons will suggest that the procedure be scheduled with either intravenous sedation or rarely under general anesthesia, so intraoperatively, there shouldn't be any pain.

Post-op patients will offer complaints of tightness, eyelid swelling and temporary blurry vision, however these symptoms will clear rapidly. They are pleasantly surprised that there is little discomfort.

If a patient should experience intense discomfort, it would be wise to report this to your physician, as it may represent a "corneal abrasion" or a scratch to the external surface of the eye. This is treated by "putting the eye at rest" either by patching and/or the use of an antibiotic-steroid ophthalmic ointment.

The usual time to resolution is on the order of 2-4 days, after treatment is started. However, most physicians take preventative measures, intraoperatively, using ophthalmic ointments and temporary corneal shields (contact lenses) to protect the eyeballs, during the surgery. Furthermore, the nursing staff will remind patients emerging from anesthesia not to rub their eyes and accidentally injure themselves.

The other scenarios in which a patient may experience "discomfort" after an eyelid lift include: a) suture removal; b) excessive dry eye. Some individuals will experience some dry eye after upper eyelid lifts and this may be related to the stiffness of the scar. Fortunately, this is usually self limiting and can be treated by the use of saline drops and maturation of the scar.