When considering an eyelid procedure, the mode of anesthesia is a major consideration for most people. Although anesthesia techniques have advanced considerably over the years, it still carries a small risk. Virtually all major complications with facial surgery one may have heard about are due to anesthesia and not the procedure itself. Therefore, when selecting the right anesthesia for blepharoplasty, safety should be the number one concern. Because there are various anesthesia modes reasonable for eyelid lifts, you should discuss them with your surgeon. Often, the anesthesia technique offered is closely linked to the setting where the blepharoplasty procedure will be performed and include the doctor’s office, a surgical suite or a hospital. Below, you will find a discussion of the various anesthesia techniques available for the eyelids including their advantages and disadvantages. Financial aspects should probably be considered last when deciding on one anesthesia technique over the other.

General Anesthesia

General anesthesia is administered by an anesthetist. It means that the patient is asleep and not aware of any surroundings. A tube is placed in the windpipe (trachea) which is connected to a respirator machine. Thereby, all control of breathing function is usually taken over by the anesthesiologist who monitors the patient’s vital signs including heart rate, electrocardiogram, blood oxygen, blood carbon dioxide, blood pressure etc. The anesthesiologist compiles all these data to determine, which and how much inhalation gases and intravenous medications to administer. Many surgeons and patients alike shy away from general anesthesia and prefer “milder” anesthesia versions for blepharoplasty instead. The surgeon’s philosophy, experience, training, and comfort with eyelid surgery play a role in the preferences.

Where: Hospitals, free-standing and accredited surgical centers. Some doctors own surgical centers that are accredited for general anesthesia.

Pros: No pain, no recollection of the procedure, complete monitoring by anesthesiologist.

Cons: most invasive anesthesia option, nausea and vomiting are common, increase bleeding possible, sometimes long hang-over effect, longer procedure time, most stress on cardio-vascular system.

Fees: $$$; operating room and anesthesia fees are commonly charged separate.

Conscious Sedation (a.k.a. Twilight Anesthesia or IV Sedation)

In twilight anesthesia, all relaxing and pain medications are administered into the vein. The patient is breathing spontaneously without a breathing tube inserted but is usually sleeping. Additional oxygen is delivered to the nose. The anesthetist follows the patient’s vital signs and level of consciousness to administer the medications intravenously. Most of these medications are very short-lived which requires a watchful anesthetist to ensure that enough but not too much sedating and narcotic medications have been given. Once the medication drip is turned off, the patient regains consciousness within a couple of minutes ensuring a smooth awakening without coughing and retching. Twilight anesthesia is a popular choice in modern day surgery centers.

Where: Hospitals, free-standing and accredited surgical center including some accredited surgical suites in doctor offices.

Pros: No airway intubation, nausea and vomiting rare, quick wake-up, possibly decrease in blood loss.

Cons: Requires anesthetist experiences with conscious sedation.

Fees: $$$; operating room and anesthesia fees are commonly charged separate.

Local Anesthesia with or without Sedative

Local anesthesia for blepharoplasty is often compared with the experience at the dentist office. The eyelids are relatively easily anesthetized with a mixture of Lidocaine (“Novocain”) and epinephrine (adrenalin). Once the lids are entirely numb, the procedure can be performed painlessly. Because epinephrine constricts blood vessels and other vessel-dilating anesthesia medications are absent, bleeding is usually minimal. Because one is usually apprehensive before the eyelid lift, most doctors administer relaxing medications (i.e. Valium) before the procedure, either by mouth or as a one-time injection. Vital signs are usually monitored during eyelid surgery and the patient is either comfortably awake or snoozing. Because surgical training happens in hospitals and major operating rooms, some doctors may not feel comfortable with a local anesthesia technique but prefer that the patient be entirely asleep.

Where: Surgeon’s procedure room, free-standing surgical center.

Pros: Minimal administration of drugs, no nausea and vomiting, no recovery from anesthesia, decreased blood loss, less operative time.

Cons: Requires surgeon comfortable with this technique, patient will feel lidocaine needle sticks. Not possible with extensive additional facial procedures.

Price: $; fee for procedure room.

What is the Appropriate Option for your Eyelid Lift?

You should have a thorough discussion with your surgeon about anesthesia, the doctor’s experience with each mode and his recommendations. You should be honest regarding your preferences. There is not one best anesthesia technique. The decision should be made between you and your doctor depending on the operative plan and preferences. Are ancillary procedures planed (i.e. browlift, facelift etc.)? Where does your plastic surgeon routinely perform eyelid procedures?

With a thorough understanding of anesthesia options with their pros and cons, you will hopefully have a pleasant blepharoplasty experience.

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