Lower blepharoplasty with only oral sedation - bad idea?

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.

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.

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.

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.

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

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

I normally perform lower blepharoplasty on patients using IV sedation (twilight anesthesia) and find that this is comfortable for patients. I would not recommend a lower blepharoplasty with only oral sedation for a family member or friend, so my general recommendation would be not to have it with only the oral sedation. Having said that, if only skin were being excised, I think this could be done with just oral sedation. If fat is also going to be addressed, I would recommend IV sedation.

I have done 1000's of eyelid operations over the last 40 years. My first choice now is a "light" general anesthesia. This does add some additional expense, but patients experience NO pain and are always happy they paid the extra money. In my pre-op consultation, I discuss the options with the patient, and together we make a decision. If patients exhibit "anxiety", or have a history of claustrophobia, hypertension, cardiovascular disease, neck or other body pains/issues such as lying still on their back, then a "light general" is always best. Happy patients that experience no pain or medical issues during their surgery send their friends !

In our practice, we perform lower blepharoplasty procedures under general anesthesia for patient safety and comfort. Board-certified physician anesthesiologists administer the anesthesia. It's a bad idea to try to do lower blepharoplasty under local anesthesia, since it's quite painful.

The amount of sedation or anesthesia required for a comfortable lower blepharoplasty will depend on what type of lower blepharoplasty is being performed. For more complex lower blepharoplasties were the bony rim is involved, you may need more anesthesia to feel comfortable. For less complicated procedures were there is less manipulation fo the skin, fat, or muscle, you may only need oral sedation. If you are having anxiety from the possibility of feeling something during surgery, you may want to discuss the options of IV sedation or general anesthesia with your surgeon to have the best experience. Hope this helps!

Johnson C. Lee, MD
Board-Certified Plastic Surgeon