Can eyelid surgery be done without anesthesia?

I'm assuming you are asking about which anesthetic options you have, not whether or not local anesthesia is needed.  Almost all doctors in this country will use a local anesthetic while performing any blephaorplasty surgery, for the reasons listed in the posts below.

Local anesthesia - Almost any surgery can be done under local anesthesia.  Upper blepharoplasty alone, with or without remodeling of the fat, can be performed under local anesthesia.  The patient is completely aware that surgery is being performed.  This can be an anxiety-producing, even traumatic experience for the patient.

Oral sedation - Patients having a blepharoplasty under local anesthesia often will request valium or a similar oral medication.  This "takes the edge off" the anxiety the patient might otherwise experience during the surgery.

IV sedation - Local anesthesia can be supplemented by IV sedation.  For light IV sedation, i.e. versed in small doses, a monitored setting is usually adequate.  It is not acceptable to administer versed in an office without monitoring in my opinion.

IV Sedation - Local anesthesia with IV sedation.  Often called "twilight" sleep, many surgeons will use a board certified anesthesiologist to administer the sedation.  This provides extra safety in a deeply sedated patient.  The patient is usually minimally aware or unaware of the surgery. 

Light general anesthetic - In our practice this is performed by a board certified anesthesiologist.  The patient goes to sleep, and when they wake up, the surgery is done.

For upper eyelid surgery, often skin is removed from the upper eyelid crease.  The fat is often reduced or remodeled.  In revision cases, often fat fascial grafts (LiveFill) are used to restore fullness and reduce hollowness.  If there is brow drooping, this should be considered as well since eyelid surgery does not fix brow drooping.  Asymmetries or the eyes and brow, differences in the set of eyes (i.e. orbital dystopia), conditions which may be affected by the eyes (dry eye, lid laxity, ptosis or drooping of the eyelid muscle) should all be considered and a plan formulated to treat them.

For lower eyelid surgery, this is a much more complex issue.  Asymmetries are very important to consider preoperatively, as well as the set of the eyes.  Whether fat reduction from inside the eye combined with resurfacing on the outer eyelid (transconjunctival blepharoplasty), remodeling of the fat or grafting (arcus marginalis repair or LiveFill), cheek lifts (subciliary, minimal incision, augmentative- i.e. USIC or LUSIC, Endotine, temporal/intraoral).  All of these should be carefully planned prior to surgery and your doctor should be fluent in these techniques.

All surgeries can be done without anesthesia, but there will be considerable pain. I think what you may really be asking is do I have to go to sleep to have a blepharoplasty? The answer is no. Local anesthesia by way of needle injections can make the pain nerve fibers not respond to the surgery. Thereby causing no pain and then you would have your eyelids done.  You may also have oral medications to further relax you prior to the needles. So it really depends on you and your doctors techniques.

Safe surgery.

Michael J. Brown, MD

The Loudoun Center for Plastic Surgery,

Virgina & Washington, DC

Some type of anesthesia is necessary for eyleid surgery.  Most cosmetic surgeons place local anesthesia (freezing) to the eyelid tissues prior to the surgery.  This helps with two parts of the surgery:

1. It helps for the patient's comfort
2. It decreases bleeding since most use a drug called epinephrine in the local anesthetic

The majority of physicians also give some type of relaxing medication at the same time.  This may be given in pill form or utlizing the services of an anesthesiologist or a nurse anesthesist.  My preference is local anesthesia and the anesthesiologist in an accredited operating room. 

The reason for this is that I want my patient comfortable throughout the procedure.  Also in rare circumstances, a patient's heart rate may respond to the epinephrine, causing increased blood pressure and a racing heart rate.  Should this occur, the anesthesiologist can easily control this while I complete the eyelid lift.

Eyelid tissues are very vascular and they bleed easily. Local anesthetic, at the minimum, must be used to decrease pain and bruising. Occasionally, a little oral sedation might be helpful. You do not need to go to sleep to have eyelid surgery.

However, you are the best judge of your pain tolerances. You may not want to know what is going on and might do best with IV sedation or general anesthesia. Good luck.

Dr. Shah

Upper lids can be done with local anesthesia to numb the tissues. If you are very calm, that might be all you need. If you are slightly anxious, some sedation either oral or IV can help. If you are very anxious you might be best with a brief general anesthetic.

Lower lids are more complex and usually require some sedation or general anesthesia in combination with the local anesthetic.

Once you have selected the best doctor for your care, ask them how they would recommend you do this. You want the surgeon to be in their "comfort zone" doing things as they usually prefer to do them to get your best result.

Some form of anesthesia is needed to do any kind of surgery. There are generally three levels of anesthesia - local, sedation, and general. Local is similar to what most dentists will administer. It involves injecting numbing medicine at the area to be operated on. Sedation involves some sort of medication which alters a person's state of consciousness. In general sedation will not require a breathing tube and is fairly easy to rebound from. General anesthesia is what is thought about for most surgeries. In this type of anesthesia, the patient is completely asleep, requires a breathing tube and can take a day or two to recover.

Eyelid surgery can be done with any of the three types of anesthesia. Upper eyelid surgery is probably most commonly done using local anesthesia though there are circumstances where sedation or even general is necessary. Lower eyelid surgery is a bit more complicated. There is usually more involved with lower eyelid surgery than upper eyelid surgery and there is probably an even split to be able to perform the surgery using local, sedation, or general anesthesia. There is no answer for every situation and consultation with your surgeon, specifically expressing your wishes for the type of anesthesia are very important.

Hope this help.

Hi Carole,

Upper and lower eyelid surgery is usually performed in my office under anesthesia.  Local anesthesia with "adrenaline" is injected just under the skin about 5 to 10 minutes prior to the treatment.  The only exception is if there is excessive fat pad protrusion in the lower lids, then I prefer having the patient under sedation anesthesia.  Choose your surgeon carefully. Good luck.

Dr. P

I do virtually all of my upper lid blephs in the office under local anesthetic, and I do most of my lower lids, through the inside of the lower eyelid, under local anesthetic. I give all patients a pill to help keep them relaxed. However, different doctors have other philosophies, so they are not wrong if they do not feel comfortable doing it this way.

Sincerely,

David Berman, MD