Local Anesthesia Question Rephrased?

I posed a question, but perhaps I wasn't clear. I'll rephrase: I understand that a lower blepharoplasty performed under LA provides better results than when performed under GA. That is because the patient can look up during the procedure, revealing the precise location of fat pads. If that's the case, wouldn't it be better for a bleph and FL to be done separately- assuming a facelift is done under GA? Or, can I move my eyes, during a facelift? I would prefer GA only if results are equal to LA.

Doctor Answers 8

Local Anesthesia for Lower Eyelid, Blepharoplasty Procedures

Lower eyelid procedures can be done safely under local anesthesia with oral sedation, IV sedation or general anesthesia.  I use all these approaches safely and determination which method of anesthesia is best  is determined at the time of the initial consultation.

Orange County Plastic Surgeon
4.9 out of 5 stars 157 reviews

Local Anesthesia for blepharoplasty

Lower blepharoplasty is usually done under either general or sedation anesthesia (and not local). This is to ensure the safety of the patient as well as the comfort of the patient. There are important muscles and nerves that are required for vision and obviously your safety is the first concern. The amount of fat to remove is usually determined at your consultation via physical exam (and not at the time of surgery).

Sandy Sule, MD
Dallas Facial Plastic Surgeon
4.3 out of 5 stars 13 reviews

Blepharoplasty and facelift

  A lower eyelid blepharoplasty is best performed under general anesthesia since there are deep proprioceptive nerve endings in the fat pads of the lower lids which do not numb up to local anesthesia. That translates to pain and conscious awareness if done under local anesthesia. It is best to perform lower blepharoplasty under general anesthesia. The amount of fat removed  through a  trans-conjunctival approach is made at the time of the consultation and confirmed on the morning of surgery prior to being placed asleep under general anesthesia.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 146 reviews

Lower Eyelid Procedures Under Local Anesthesia

The choice of anesthesia doesn't make a difference to the success of a lower eyelid procedure.  Although, in our practice both lower eyelid blepharoplasty and facelifts are done frequently using local anesthesia, there is no disadvantage of doing these under general anesthesia if that is the preference of the surgeon.  You can also do the eyes under IV sedation then the anesthesiologist can transition to GA.  The key as with any facial cosmetic procedure, just make sure your surgeon is experienced and does several of these procedures per week.  Also, look at there before and after gallery to confirm you like the outcomes they get. The more before and afters you see the better. 


Amir M. Karam, MD
San Diego Facial Plastic Surgeon
4.6 out of 5 stars 114 reviews

Local Anesthesia versus General Anesthesia for eyes and facelift

I believe the results are comparable. Marking can be done before surgery and there are maneuvers that can be done while under general anesthesia to locate the protruding fat pads. The compromise, if you are still concerned can be that a part is done under iv sedation with the facelift being done under general anesthesia. Make sure you seek a board certified plastic surgeon for further details regarding your specific concerns.

Raj S. Ambay, MD
Tampa Plastic Surgeon
4.3 out of 5 stars 35 reviews

Local Anesthesia Question Rephrased?

          I think there is an easy compromise on this.  The eyelids can be performed under local anesthesia with or without light sedation.  General anesthesia can then be used for the rest of the facial procedures.  I do not think the results are different, and I perform both under general.  Find a plastic surgeon with ELITE credentials who performs hundreds of facial and eyelid surgeries each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 reviews

Anesthesia for lower lid blepharoplasty

You can have very good surgical outcomes for a lower lid blepharoplasty under any time of anesthesia, be it local, IV, or general.  The fat pads can be marked before surgery while you are still awake, and gentle pressure by the surgeon during surgery makes them more obvious as well.  I generally prefer to do my cases under IV sedation because the patients seem to be the most comfortable.  But, this decision should be between you and your surgeon, based on your needs and medical history. The type of anesthesia should not cause any difference in your outcome. 

Good luck

Dr. Mohadjer

Jasmine Mohadjer, MD
Tampa Oculoplastic Surgeon
5.0 out of 5 stars 2 reviews

Local Anesthesia Question Rephrased?

In my experience there is not a difference in lower blepharoplasty results under local, IV sedation or general anesthesia with the exception that sedation or general tend to be more pleaseant for the patient. We typically have the patient look up when photos are taken at the pre-op appointment to determine where the prolapsing fat is located, how much is there and the degree to which symmetry exists. This provides great intraoperative reference. You do not need to be able to do this during surgery as that information is provided by your photos. You can choose to have your procedure performed under local, IV sedation or general anesthesia and expect very similar results. I hope this information is helpful.

Stephen Weber MD, FACS

Lone Tree Facial Plastic Surgeon

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
4.9 out of 5 stars 129 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.