Consultation: Nope, This Just Didn't Seem Worth It to Me, Sad to Say - Augusta, GA

Today I had my consult with the surgeon...

Today I had my consult with the surgeon recommended to me for lower blepharoplasty. Everyone in the office was very pleasant, but it was definitely a medical setting (no spa-like atmosphere-my dentist's office has a cozier waiting room). In July, I'd had my yearly eye exam and checked with my optometrist re: whether or not my saggy upper lids were impacting my peripheral vision--nope, all was perfect. So, I went in today knowing that this would be an elective, cosmetic procedure out of pocket--and remember, it's my *lower* lids that are bugging me. Uppers are just something I'd throw in because why not (do it all at once if needed).

I probably was asked half a dozen times if I'd had my optometrist check my peripheral vision (the doctor even 'explained' the test to me like I was ignorant). He suggested I get a second opinion, and I did write down the name of the other fellow, just in case.

Anyway, like I said, everyone was courteous. It took 70 minutes for me to be called back to the appointment room. The doctor came in, was friendly and introduced himself. He immediately started focusing on my upper lids, saying he thought he could help there, and when I reminded him about the lowers being my concern, oh, yes, those could be fixed, too. 45-60 minute surgery, done in their suite at the hospital, MD anesthesiologist, 1 week of recovery.

I then asked the $64 million dollar question--the one I got answered here from the experts (a wide range of mostly well-explained answers) and did loads of reading on (including watching 3 surgeries on YouTube--I'm not an MD, but I'm a Ph.D., so it's pretty fascinating) because it is a HUGE issue.

"Can you do this with just local anesthesia and light sedation? I have a long and significant history of PONV, and extreme vomiting while recovering would be difficult." He told me no, it would be too painful, but that the day before surgery, the anesthesiologist would call and answer any questions I had. I asked him what agents were used and read off my list of things I couldn't have. He said he didn't know; I'd have to wait for the anesthesiologist to call me the day before surgery, but he was sure something could be worked out. And then...he said good luck, good bye, and left. I got pictures done, initialed some general forms, and left. 120 minutes of driving, 70 minutes of sitting, and 10 minutes of actually speaking to a doctor or nurse. Oh, and yes, one more time, as I was leaving: "Definitely call the other optometrist before you schedule your surgery!" Well, folks, you're very nice, but without assurance on the anesthesia, I'm NOT scheduling.

I'm sorry the doctor couldn't have given me more helpful answers, such as, "I see you have legitimate concerns about nausea and vomiting, and that knowing your options are important. How about I see if Dr. Anesthesia could call you and discuss this before you schedule? That way, you can make an informed decision." Or, "I really am not comfortable with just local and sedation, but I see you are concerned about PONV. My colleague, Dr. Eyeball, often does this surgery with local anesthesia and light sedation. Could my staff help you with a referral?"

I'm a bit sad and letdown because I know there are doctors who are perfectly fine with the anesthesia I wanted. However, barring a lot of travel and taking time off from a busy job, this may just have to be put on hold until retirement in 10 years.

If anyone HAS had blepharoplasty in the Augusta or Athens GA area with local anesthestic or local plus light sedation (by this, I mean something like Valium or Xanax--NOT propofol and Versed), I'd love to know.

Bottom line: Ask questions and get all the answers you need to feel at ease before taking such a major step. :)

Best to all,

dee

The Followup Call--they must REALLY want to do my eyelids!

I got a call today from the nurse I met yesterday saying she'd set up the optometrist second opinion. I was kind of shocked--I didn't know this would happen! (And I was at a conference, so caught a bit off guard). I thanked her and again said that everyone in the office had been so nice and very caring--but I had made the decision not to have the surgery. She was quite surprised and wanted to know why--she asked in a caring, concerned way. I told her that it was because the anesthesia question wasn't well answered, and that without knowing ahead of time that I wouldn't have propofol and Versed, I couldn't agree to it. She urged me to at least get the optometrist's opinion and again, "The anesthesiologist will talk to you before the surgery; they're very good here." Thanking her again, I told her that unless I could know for certain what drugs would be used, I couldn't have the surgery due to the extensive nausea and vomiting--I'm not even having a colonoscopy with that particular cocktail--my GP is finding someone to do it without them or else using Cologuard. THAT got the nurses's attention...and finally, she understood. She said after the optometry visit, she'd talk to the plastic surgeon and stress that I needed to know the anesthesia plan for medical reasons/prior reactions and perhaps he would be okay with local + Valium in my case. I thanked her again for her concern, and I see the optometrist next week. If he says there's no medical indication, I wonder if that changes things.

Wow, these folks want me there badly---odd, but I'm still under no obligations to go with the surgery. And a second eye check isn't a bad thing. Does anyone have thoughts on all this?

And the optometrist visit

Just as I had told the folks at the plastic surgeon's office, my regular optometrist said I did not have peripheral vision issues. But they made an appointment for a 2nd opinion, so off I went (2 hours of driving for 30 minutes of clicking with my eyeballs taped open--unpleasant, but not painful)--and just as I had said--no significant loss. 9% in one eye, 10% in the other; insurance requires 25%. I'm glad we've met our deductible this year because I would not be happy with wasted time and money. The PS's office emailed to confirm what I already knew and said they were aware of my anesthesia issues and agreed to work around them, but I thanked them and said I would not be pursuing this at the present time. I'm going back to Sephora and trying higher quality gels and ointments for the moment. I think this backs up what many people on here have said--don't do this unless you feel VERY at ease with the whole process. For me, a 'consultation' meant a real conversation, not a run in/run out 5 minutes with the surgeon. Good luck to all considering future procedures! I know there are doctors out there doing amazing work. :)
Dr. R. Smith (consult)

I though the office staff were exceptionally professional and pleasant. Dr. Smith, while 'hurried,' seemed courteous and skilled. However, I'm a nosy, detail-oriented patient. I want to hear the big words (hey, I can spell blepharoplasty--so it's fine to say it) and all the info before I make a decision, not just, "well, you can ask the anesthesiologist about that the day before your surgery." If it's information I need to make the decision to HAVE the surgery in the first place--that's a bit of a challenge. Anyway, since this is an elective, cosmetic procedure, I decided not to do it. I think this would be a great practice for the patient who only wants the basic info and to let the doctor make all the decisions without much input from the patient. I think the practice would take good care of you, as long as you let them have free reign as opposed to being partners in care (the doctor being the medical expert, the patient being the expert on his/her body and physical needs to feel at ease). Again, everyone was professional and friendly, and several patients recommended the doctors here, so this may be a good practice for you.

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