Is lower blepharoplasty with fat repositioning ever done as an office procedure without IV sedation or General Anesthesia?

I have had two consults and not sure why one would do with and the other without.

Doctor Answers 15

blepharoplasty procedure

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A lower blepharoplasty procedure is performed usually under deep IV sedation or general anesthesia. This is not performed in an office/ clinic setting, since this is real surgery and patients need to be monitored. In our practice, we perform fat removal, not repositioning  in the lower lids through trans conjunctival approach under a brief general anesthesia administered by a board-certified physician anesthesiologist for patient safety and comfort.  The fatty deposits in the lower lids have deep pain fibers and is very difficult to do this procedure without being placed completely asleep under anesthesia. Trying to perform the surgery  under local anesthesia patients will have conscious awareness of a very painful procedure

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 155 reviews

Blepharoplasty and IV sedation or general anesthesia

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I have always offered and done blepharoplasty procedures (upper, lower, extended lower or both) with local anesthesia, usually with oral sedation but no IV. This keeps the cost, risk, and recovery issues to a minimum. If the patient doesn't feel comfortable with this and might not hold still then IV sedation can be offered in the office setting without an anesthetist or anesthesiologist, assuming the surgeon is experienced with this and has proper accreditation for the level of sedation used. This applies to "fat repositioning" as well. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

Blepharoplasty as an office procedure

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While an upper lid blepharoplasty can be done with just local anesthesia in an office setting, A lower lip blepharoplasty is more challenging, and requires some degree of sedation. I personally prefer that the sedation be mostly at the initial infiltration of the anesthesia and then let it wear off enough so that you can cooperatively open you eyes at the end of the procedure.  This  permits planning removal of enough skin to remove the excess, but not so much that you are unable to fully close your eyelids.

Good luck.

John M. Weeter, MD
Louisville Plastic Surgeon
5.0 out of 5 stars 7 reviews

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Anesthesia for Lower Blepharoplasty with Fat Repositioning

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Lower blepharoplasty with fat reposition can be done under pure local anesthesia in the office. The questions are, is it safe and is it best for the patient. I do not think  it is either. The procedure is relatively extensive and very difficult for almost everyone to tolerate without significant sedation. For that kind of sedation, the procedure needs to be in an accredited facility with all the things necessary for general anesthesia. Because of this and the fact that general and significant sedation cost the same, I prefer general anesthesia. Even if local anesthesia can eliminate the pain, because of the extensiveness of the procedure and its location around the eyes, it is hard to eliminate the anxiety which can increase the risk of bleeding, a major problem with this procedure. Most of the physicians I know who do this procedure in the office under purely local anesthesia are those who cannot offer other types of anesthesia because they do not have privileges in an accredited facility.

Robert T. Buchanan, MD
Highlands Plastic Surgeon

S lower blepharoplasty with fat repositioning ever done as an office procedure without IV sedation or General Anesthesia?

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I offer my patients either IV sedation or if the lower blepharoplasty accompanies a facelift a light general anesthetic. I would recommend against having the procedure performed under local anesthesia alone.  Most surgeons would choose the procedure that provides the least stress for themselves and their patients if given the choice.  I think that the presence of an anesthetist providing sedation provides an additional safety factor.  Good luck with your decision.

Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
Beverly Hills, California

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 31 reviews


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Some physicians will do this under local. I do it under general because that's how I'd want it if I were the patient, but I am often doing other things with the lower bleph as well. I would be more concerned with the technique differences.

Tracy E. McCall, MD
Milwaukee Plastic Surgeon
5.0 out of 5 stars 1 review

Lower lid blepharoplasty anesthesia

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I have been doing the lower lid surgery and other facial surgeries all without excwption with sedation only. There is no need whatsoever to have the risks of general anesthesia for these procedures at all.

Afshin Farzadmehr, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 57 reviews

Anesthesia type for lower blepharoplasty

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The type of anesthesia for lower blepharoplasty depends on the comfort of the patient and the comfort of the surgeon. Lower blepharoplasty can certainly be done under local anesthesia (see video below) if both the patient and surgeon are comfortable that way or it could be done under conscious sedation (IV sedation). However, general anesthesia is generally overkill and unnecessary.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 88 reviews

Is lower blepharoplasty with fat repositioning ever done as an office procedure without IV sedation or General Anesthesia?

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Thank you for your question. Lower blepharoplasty can be performed under local anesthesia this all depends on the patients comfortability. ı recommed for exam and consultation with your surgeon one on one before your procedure.

Bulent Cihantimur, MD
Turkey Plastic Surgeon
4.8 out of 5 stars 98 reviews

It can be done.

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I would not recommend general anesthesia for this.  That means that you can not be asked to look up and down during surgery.  That bit of movement is very helpful to monitor the effect of surgery and assure that surgery is optimally performed.  That can be done under IV sedation.  Having this surgery under local anesthetic is stressful for both the surgeon and the patient.  Some surgeon to offer surgery this way.  Generally they are doing the procedure in an office procedure room that is not accredited.  The accreditation needed to offer intravenous sedation in most states means that the office has met a lot of standards that are designed to increase patient safety.  

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 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.