My Preoperative Experience and Twilight Sedation

My experience with Dr. Britto has been exemplary in every way. After having consulted with three other oculoplastic surgeons I arrived decisively on Dr. Britto as a result of his extensive experience with complex cases and his admirable bedside manner. It was obvious to me that Dr. Britto is a very intelligent and careful surgeon, one of those rare doctors who prioritise adherence to his Hippocratic Oath to “first do no harm” above the prospect of financial gain from a new customer. For me the best test for integrity is when I find a professional who is willing to tell me “No” and to communicate inconvenient truths; to find someone who is willing to spell out for me in advance both the risks and opportunities of a procedure. Eyes wide open! When you find someone who has carefully considered what could go wrong, then that is exactly the person who is fully engaged and best empowered to put the necessary plans in place to effectively manage the risks to ensure the very best possible outcome.

That was my experience with Se. Britto during the four preliminary consultations before going under the knife. From the moment I first met Dr. Britto I was able to discern that he is detail-oriented, discerning, meticulous, calm, considerate, and professional. The same goes for the team of people with whom he surrounds himself: the receptionist, the nurses, the anaesthetist, the OR nurse, etc. His is a well-oiled machine. Pre and post communication is consistently excellent throughout.

I was particularly impressed by the relationship between Dr. Britto and the anaesthetist. They carefully consulted with me in my private room before the procedure, which was performed under “twilight” sedation. The purposes and functions of each compound to be administered during the procedure were discussed with me in detail, elevating my fears about not being fully unconscious. In fact, the benefits of the twilight approach have guaranteed the most aesthetic outcomes. The only thing I remember from the 3-hour procedure was near the very end when he began the suturing, when I was occasionally asked to blink, close my eyes, and squint a little. I saw nothing due to the little blinder-cups that had been placed i over my eyeballs. I heard only the calm and reassuring voice of Dr. Britto giving me a few, simple little commands. It couldn’t have been easier. I felt absolutely nothing and was in a state of what I imagine Nirvana to be: perfectly comfortable and relaxed, calm and joyful, peaceful. I expect the expert administration of propofol and fentanyl and (amongst other drugs which produce amnesia) had something to do with my perception of the apparent ease of the procedure. To me I felt only awake for the last five minutes— and inly learned that I was in “twilight sleep” for three hours before that! I have no memory of any sensations at all except peacefulness and blinking. No PTSD.

I was beautifully cared for after the procedure within my beautiful and quiet private room, where given something to eat and drink, as well as medication and instructions to take home.

I had been given preoperative instructions about three weeks before my surgery date, which I recommend carefully reading before the surgery. The thick ointment which is applied ti the eyes after the procedure renders the fine focus necessary for reading text on paper difficult.

Also noteworthy was the direct Britto-to-patient a cess I enjoyed via Whatsapp. The postoperative questions I had were quickly addressed by Dr. Britto via Whatsapp, and a day-two face-to-face meeting on a Saturday was even arranged in order to assure me that everything appeared normal and was preceding according to plan. This allowed me to rest in peace during those three days of swelling post procedure.

I am one month in now, and my eyes and mid-face are taking shape nicely. The bruising is mostly faded now. Swelling is about 60% gone. Festoons and deep circles under my eyes are completely gone. Eyelids look perfect.

I will submit photos once things have settled a bit more.