Lower blepharoplasty eye protection during surgery?

When people have under eye bulging fat pads, we typically remove them through an incision on the inside of the eyelid. The globe, or eyeball, is always protected. In our experience, after the lower eyelid incision is made, the back portion of the flap is retracted upward, with a suture, to protect the eyeball. I do agree that performing transconjunctival lower blepharoplasty would likely require twilight anesthesia, or general anesthesia, for patient comfort. I also agree that some surgeons utilize a topical numbing anesthetic in the eye, along with local anesthetic, however, we have not tried this in our practice. Thank you for this question! Sincerely, Dr Joseph

I am a fellowship trained Oculoplastic surgeon and board certified ophthalmologist. I am trained to work very close to the eye without injuring it. Plastic surgeons, facial plastic surgeons, and other types of surgeons do not have similar training and skills to work close to the eye. Generally all types of surgeons should employ strategies for protecting the eye. When I work on the upper eyelid, lateral canthus, or performing transcutaneous lower eyelid surgery, whenever possible, I place a metal shield on the eye surface. When performing transconjunctival lower eyelid surgery, a specialized retractor is used to protect the corneal surface.

Regarding anesthesia, general anesthesia is unnecessary. It is often performed as a convenience to the operating surgeon by eliminating to possible need to speak with the patient. Straight local anesthesia even with oral sedation is often less than ideal. This is generally advocated by surgeon using unaccredited exam rooms for performing surgery. Intravenous sedation with local anesthetic is probably the best balance of patient comfort and surgeon control. However this requires an accredited operating room environment.