Is Eyelid Surgery painful? Are patients usually put under general anesthesia or can they be awake?

What are the options to manage pain after surgery?

Doctor Answers 11

Anesthesia and eyelid surgery

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Pain is generally minimal after upper eyelid surgery and moderate after lower eyelid surgery. Prescription narcotic medications post-OP make most patients very comfortable and most patients are able to switch to OTC Tylenol after a couple of days. Upper eyelid surgery can be performed strictly under local anesthesia without any sedation (fully awake), whereas lower eyelid surgery usually requires some form of sedation or general anesthesia.

Pain During and After Eyelid Surgery

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Eyelid surgery is regularly described as patients to be among the least painful of cosmetic procedures. Local anesthesia is generally administered during the procedure and is sometimes accompanied by oral or intravenous sedation for further comfort. Though you will technically be conscious during the procedure, you will literally be sleeping during the surgery. The great majority of patients have a fast recovery period often without the use of analgesics or painkillers. I frequently use sedation or twilight anesthesia for blepharoplasty patients and patients who have had general anesthesia, generally prefer sedation as it is a much fast recovery and more pleasant experience

Eyelid Surgery Under Local

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Thank you for your question.  

Local anaesthetic is strictly used for upper eyelid surgery, due to minimal pain.  It can also be used for lower eyelid as well, however it will depend on patients pain threshold, to whether they opt for local or general anaesthetic for the lower eyelids.  Lower Eyelid Surgery is more sensitive due to removal of excess skin and fat is removed or re-draped to improve the contour of the lower eyelid. 

Surprising there is little after pain as well.  The vast majority of patients need no more than paracetamol.  Different people heal at different rates, but about 70% of the swelling and bruising is gone after one week.  About 90% of the swelling and bruising is gone after two weeks.  After two weeks, it is often difficult to tell that the patient has had eyelid surgery.

Best of Luck 

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Eyelid Surgery Under Local

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 Eyelid surgery, in general, is not painful if done in a skillful manner by a Board Certified Plastic Surgeon or Oculoplastic Surgeon with expertise in Blepharoplasty. I would recommend that you have monitored anesthesia by either IV sedation or general anesthesia to optimize safety during and after the procedure.

Rod J. Rohrich, MD
Dallas Plastic Surgeon

Surgery questions

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This is a very broad question because "eyelid surgery" can span a wide variety of procedures. Let's assume we are talking about probably the most common eyelid surgeries: upper and lower blepharoplasty.

Answers will vary widely for these questions because much of it depends on the personal preference of the surgeon and also the desires of the patient. Bottom line is that there are lots of options.

In our practice, cases are typically done in the operating room under IV sedation (with local anesthetic as well) or in-office with local anesthetic only. With the anesthesia on board, patients are usually very comfortable during the surgery. Post-operatively, over the counter pain medication is typically adequate to manage pain. Narcotics are almost never necessary.

Eyelid Surgery

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Thank you for your question about eyelid surgery.

Eyelid surgery typically is not very painful compared to the many other surgeries plastic surgeons do.

It usually can be done awake or under general anesthesia.

To be sure, see two or more experienced, board-certified Plastic Surgeons, occuloplastic surgeons or facial ENT surgeons in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have surgery.

I hope this helps.

Eyelid surgery performed under general anesthesia

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Eyelid surgery can be rather uncomfortable during the surgery itself because injections have to be placed in the skin and fat  for the local anesthesia. The fat pads have deep pain fibers that sometimes do not get fully anesthetized, therefore we place patient under general anesthesia  when fat removal is required for upper or lower eye lid surgery. There is very little pain associated with patients after the surgery during their recuperation. For many examples, please see the link and the video below

Not all eyelid surgery is the same!

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This is a great question, because depending on the doctor that you go to, you will get very different answers.

My personal preference is to do Upper eyelid surgery with numbing medication around the eyes (local anesthetic) and have the patient 100% awake (ie, no Valium, no Xanax). The patients that have their upper lids done that way are always the happiest! They do not feel any pain, they have minimal bruising, they don't get nauseous and we're able to have a very enjoyable conversation throughout the entire procedure. We listen to music and at the end of the case, you feel completely comfortable. Some patients are still nervous, so I have no problem prescribing an anxiety pill - but that is patient dependent. 

For lower eyelid surgery - I always do that in an outpatient procedure setting, with minimal sedation (ie, twilight or IV sedation). Most patients describe this as an amazing nap. It is very comfortable and safer than general anesthesia. Also, depending on what medications you take and your medical conditions, if it is safer, than I will do an upper eyelid surgery in the procedure room as well. Safety always dictates the final decision. 

Some of my good friends, who are general plastic surgeons or even other eyelid surgeons, will do eyelid surgery under general anesthesia. Personally, I think this is putting the patient under unnecessary risk. Eyelid surgery alone does not require general anesthesia, unless you are having another procedure done at the same time (ie, a facelift or nose job). If your surgeon is telling you that you need general anesthesia for an eyelid procedure, they might not be using the latest techniques. 

As far as pain after surgery is considered. Everyone's perception of pain is different, so it is impossible to answer that directly. But to give you a framework, here are some key points. I never prescribe prescription pain medications or narcotics. I call all my patients the night of their surgery and remind them to take over-the-counter Tylenol for the first few days after surgery. Most of my patients say that they stopped using Tylenol after the 2nd or 3rd day. Again, in my humble opinion, if you have so much pain after eyelid surgery that you need narcotics, your surgeon hasn't done a thorough job coaching you through the post-operative process or something might be amiss. 

Again, this is a great question. I hope it helps, but don't be too distraught by the multitude of answers. As long as your surgeon has a good reputation and is driven by safety, then I would follow their recommendation. Thanks!

Dan Landmann, MD
Ridgewood Oculoplastic Surgeon
5.0 out of 5 stars 47 reviews

Is Eyelid Surgery painful? Are patients usually put under general anesthesia or can you be awake?

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Eyelid surgery can be performed under local (awake) or general (asleep) anesthesia. The decision for the type of anesthesia used during surgery depends on the comfort level of the patient and surgeon. Pain after surgery is generally managed with prescription narcotics. Thank you for your question. Best wishes.

Eyelid surgery pain and anesthesia

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Eyelid surgery can be performed under a variety of anesthesia techniques.  The decision of the type of anesthesia to use is up to the surgeon and the patient, and the anesthesiologist if there is one being used for the procedure.  Generally speaking, if the eyelid surgery is the only procedure being done, I believe most surgeons would perform this without general anesthesia.  The procedure can comfortably be done with IV sedation and local anesthesia.  If there are multiple procedures being done, then it is possible that a general anesthesia would be preferable.  For most patients, there is not significant pain after the procedure.  Sometimes Tylenol may be all that is needed or some surgeons may prescribe a stronger pain medication if needed.   

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 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.