I Am Having an Upper/lower Bleph, No Health Issues. Will I Be Comfortable Enough with Just Po Benzo and Local? I Am Nervous

I Am Having an Upper/lower Bleph, No Health Issues. Will I Be Comfortable Enough with Just Po Benzo and Local? I Am Nervous :(

Doctor Answers 8

Anesthesia choice for upper and lower bleph

We do not recommend upper and lower lid surgery performed under local anesthesia with a little bit of Valium.  There are deep proprioceptive fibers and fat pads that are quite painful to remove as they do not adequately numb with local anesthesia.  It is always best to have these performed under a brief general anesthesia for the patient’s comfort and safety.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Eyelid surgery with oral sedation.

As with most responses, this is perfectly acceptable method for some patients. It seems with your concerns you may wish to discuss IV sedation with your surgeon as you will be more sedated and less aware of the procedure. 


Communication is key and you need to feel comfortable with the decision. Of course, you will always have some nervousness before any procedure, but anxiety should be minimal.

Brian J. Lee, MD
Fort Wayne Plastic Surgeon
5.0 out of 5 stars 12 reviews

Anaesthesia is taylored to the patient

It is very common to perform Blepharoplasty with local anaesthesia. Having said that some degree of sedation is often nice for the patient and can make the surgery easier for the surgeon. An oral sedative can relax patients significantly but if you are really nervous a more powerfull intravenous medication could be considered.

Thomas Buonassisi, MD
Vancouver Facial Plastic Surgeon
4.9 out of 5 stars 105 reviews

Anesthesia for eyelid surgery

Some patients do well with a little valium-like pill just before their surgery.  I just did one last week like that in the office, and the woman did great.  But a month before I tried that for a patient (a nurse) who was familiar with the procedure, and with me.  And she seemed very calm in the office.  But after the injection of the numbing agent she became uncontrollably anxious and her blood pressure sky-rocketed to the point where we never were able to start the procedure.


So my point is it can be unpredictable how you will react to the entire process that day.  I will say that is not an issue, and you are certainly safer in a licensed surgical facility that can administer IV sedation.  Plus, you sleep lightly through the entire procedure, so it is always a much better experience.  Thus, in general, I encourage my patients to go to the surgicenter.  Because I am always making sure my patients are comfortable, if you are asleep, I don't have to be as concerned with how you are feeling and can concentrate more on your procedure.


Yoash R. Enzer, MD

Yoash R. Enzer, MD, FACS
Providence Oculoplastic Surgeon
3.4 out of 5 stars 8 reviews

Patient dependent

This is absolutely a personal decision. From a saftey standpoint, it is not an issue. Many surgeons across the country use this approach almost exclusively and do quite well.

In our practice, we provide the patient with the option of deep IV sedation vs Oral sedation for blepharoplasty. Lower blepharoplasty is a bit more involved, and can cause a bit more anxiety for the patient, but I've done it without problems in dozens and dozens of patients without an issues. The savings from the anesthesia is a couple/few hundred dollars, and to some that is a big difference. If the cost isn't an issue, you will be more comfortable with twilight sedation. The ball is in your court. Now if you really like your surgeon, and he/she doesn't offer it, then its a little tougher decision. You may want a second opinion.

Good luck

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 37 reviews

Discuss anesthesia needs with your surgeon

typically I perform uncomplicated upper blepharoplasty under oral sedation with local analgesia; however, I prefer to perform upper and lowers under iv sedation with monitoring for comfort and safety. many surgeons perform upper and lower blepharoplasty under local analgesia with oral sedation with our any problems. Discuss your concerns with your surgeons so that you are not surprised or anxious during the procedure if you choose to proceed with oral sedation alone.

Edwin Ishoo, MD
Cambridge Facial Plastic Surgeon
4.4 out of 5 stars 20 reviews

Blepharoplasty Under Local is Safe

Blepharoplasty is routinely safely preformed under local anesthesia as your describe.  Patients are able to tolerate the procedure and are comfortable after the area has been numbed.  The advantages are:

- No general anesthesia

- Cost savings


The disadvantages;

- Requires cooperation from the patient


It will be up to you what you feel comfortable in undergoing.  It is completely normal to be nervous for the procedure.  You have to make the decision if you feel comfortable to undergo the procedure without general anesthesia.  


I hope this helps!

Jonathan Kulbersh, MD
Charlotte Facial Plastic Surgeon
5.0 out of 5 stars 66 reviews

Eyelid surgery anesthesia

Every practice has its own policy but in my experience, a nervous patient does not do well with p.o. sedation and local especially in the lower eye region and if any fat work needs to be done.  You might re-visit this with your surgeon so you have the best experience.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 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.