Lower blepharoplasty with only oral sedation - bad idea?

Question

I am scheduled for a lower bleph next month. When I spoke with the surgeon, I said I wanted twilight sedation, to which he said yes, however when the nurse called me today, she explained that he may or may not use intravenous sedation and often uses just oral sedation. This seems risky to me. Is that adequate? I spoke with one woman here who had only the oral sedation and she said it was very unpleasant. Now I'm worried - about pain and freaking out while under the knife.

Melanie Ho Erb, MD · Answer

I perform lower lid blephs both in my office procedure room with oral sedation and at a surgery center under twilight anesthesia.... but more often in my office procedure room. The effective amount of oral sedation to make you fall asleep and the amount of anesthesia needed directly into the area varies quite a bit from patient to patient. So speak up if you are not totally sleepy because you can get more oral sedation. And speak up if you feel any tingle around the area so that you can get more numbing injection. Virtually all of my patients have no pain. But one did and never flinched or moved or said anything the entire time so I had no idea she was in pain. Speak up and it won’t hurt and you will probably just fall asleep. Lastly, in my office procedure room with oral sedation, I use lenses on the eye so you can’t see anything, relaxing music, lots of numbing medicine, and relaxing pills so most patients just fall asleep during the procedure.

Kenneth D. Steinsapir, MD · Answer

Generally this mean that your surgeon intends to perform your surgery in an unaccredited office procedure room. This can save substantial money. Intravenous sedation can only be administered in accredited surgery center. These require certain staff, resources, and procedures that significantly increase patient safety and comfort. Can you have lower eyelid surgery without intravenous sedation. It is a bit rough. You will be far more comfortable with more sedation than your surgeon is planning. If you do not want what your surgeon is planning, cancel surgery. If they have taken your money, ask for your money back and go find a surgeon who offers what you want.

Michael P. Morrissette, DDS, FACS · Answer

You need to feel comfortable with the type of anesthesia for your surgery. There are many surgeons who perform this surgery with local anesthesia and oral sedation. I prefer the use of intravenous anesthesia or "twilight anesthesia" for a few reasons. We use protective eyeshields which protect the eye and these can be uncomfortable even with topical anesthetic drops. Sometimes patients under local anesthesia will not be entirely anesthetized and require more local anesthesia. Lastly, some patients don't want to hear anything during the surgery and prefer to wake up when the surgery is complete.

Mehryar (Ray) Taban, MD, FACS · Answer

Lower blepharoplasty can be performed under local anesthesia with oral sedation as depicted in attached video.  The choice of anesthesia depends on the patient and surgeon. Best to discuss with your surgeon.

Tanveer Janjua, MD · Answer

I do most of my lower blephs under oral sedation only without any issues. The combination of Alprazolam and Hydrocodone makes patient relax. However the surgeon has to be excellent with local anesthesia otherwise it will hurt. 
Regards
Dr. J

Brian K. Machida, MD, FACS · Answer

Lower blepharoplasty can be done routinely with oral sedation as long as the local and topical anesthesia is sufficient to numb the area.

Lower blepharoplasty with only oral sedation - bad idea?

Answers (11)

Answer: Lower blepharoplasty under local anesthesia with oral sedation

Answer: Lower blepharoplasty under local anesthesia with oral sedation

Answer: Lower blephs under local with oral sedation

Answer: Lower blephs under local with oral sedation

Answer: Not a bad idea

Answer: Not a bad idea

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Lower blepharoplasty with only oral sedation - bad idea?

Answers (11)

Answer: Lower blepharoplasty under local anesthesia with oral sedation

Answer: Lower blepharoplasty under local anesthesia with oral sedation

Answer: Lower blephs under local with oral sedation

Answer: Lower blephs under local with oral sedation

Answer: Not a bad idea

Answer: Not a bad idea

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Recommended reading

Everything you need to know about Eyelid Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.