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Blepharoplasty under local anesthesia

General anesthesia or local anesthesia? The patient undergoing some certain plastic surgeries can make his own decision which one of two anesthesia methods to choose.

If one decides to have a traditional abdominoplasty then ,of course, general anesthesia will be selected without even asking the patient. But if you just want to do the plastic surgery of the eyelids, then you can definitely discus your pain relief options. Blepharoplasty is sometimes performed under local anesthesia, which attracts patients seeking to avoid “deep sleep” during surgery. What are noticeable and subtle characteristics of the eyelid correction under local anesthesia?

Eyelid surgery and local anesthesia

Your decision to undergo eyelid surgery doesn't automatically exclude the possibility to have general anesthesia in your case.

To avoid general anesthesia during surgical correction of the eyelids is possible only when surgical procedure is simple and doesn't require extended times or work. For example, upper blepharoplasty. Equally important is the mental state of the person, who must be psychologically prepared to undergo surgery being conscious.

Speaking about the advantages of using local anesthesia during plastic surgery on the eyelids, it is worth mentioning the following :

  • extremely low risk of possible complications, since more “heavy” drugs are used during general anesthesia
  • the patient can move the eyelids and open-close them at the request of the doctor, which facilitates the surgery operation for the latter
  • reduced risk of insufficient or excessive eyelid correction
  • opportunity to go home on the day of surgery

But since plastic surgery regardless of the level of complexity is a surgical intervention, blepharoplasty under local anesthesia also has its own pitfalls. So they are:

  • during surgery the patient might have high blood pressure due to nervous tension. This phenomenon is not dangerous by itself but the doctor will be less convenient to work
  • there is still a risk of allergic and other reactions to drugs
  • many surgeons perform the operations with patients strictly under general anesthesia to avoid any distraction during the process.

How to perform the operation?

Whether local or general anesthesia will be used eventually the patient follows the same rules for the preoperative period. They are as follows: discontinue taking blood-thinning drugs , stop drinking alcohol and smoking two weeks before the intervention.

The patient has medical tests done. The patient's history of allergy reactions and adverse reactions to anesthetics is compiled by doctors so that during the operation there will be no complications and a threat to the health and life of the patient.

Before the surgery the plastic surgeon applies a special marking on those parts of the eyelids where the eyelid surgery will be performed. Then an antiseptic solution is applied on the entire face and local anesthetics are injected. After anesthetics kick in the plastic surgeon starts the procedure.

When the surgery is finished the patient spends several hours in the ward under supervision. If there are no complications, pain relief medications are prescribed (pills or injections) and the patient is discharged.

Does blepharoplasty hurt under local anesthesia?

So that the patient does not feel pain and is not under general anesthesia two methods are used.

  1. The first is called application technique, which involves the application of an anesthetic cream or spray locally. As a result the area becomes numb but tissue deep layers are not affected. This method of anesthesia is usually used for injections of Botox or fillers.
  2. The second method is injection technique. From the name it is clear that the anesthetic drug is injected into the tissues which allows the active substance to penetrate the subcutaneous fat and muscle layer. Usually the drug includes lidocaine, ultracaine and bupivacaine.

It's quite uncomfortable to bear the process of injecting the drugs because of the depth of injections and high sensitivity of periorbital area. There will be no pain felt during the surgical procedure but the patient will feel the manipulations applied to the site: the pressure of the instruments, the moving threads during the suturing. The process will resemble dental treatment with anesthesia, when the movements of dental instruments in the mouth are felt but there is no pain.

During blepharoplasty the patient lying on the operating table will see the light of the surgical lamps, and in case a laser is used instead of a scalpel, he also will be exposed to the smell of the burning meat. Not everyone can stay calm with such an experience, so sedatives are often added to local anesthesia to bring the patient to a more relaxed, sleepy state.

If the patient has a low pain threshold or is too sensitive, then intravenous sedation is usually recommended. The patient becomes unconscious which makes this option of anesthesia almost equivalent to general anesthesia. The only difference between these two is the dosage of drugs used and the possibility of patient's spontaneous breathing.

The duration of pain relief period depends on the amount and concentration of the drug injected. The individual characteristics of the patient's body also matter. There have been such cases when during surgery the patient felt that the effect of the anesthetic was reduced. In such a situation it is necessary for the patient to mention this to the plastic surgeon who will provide an additional injection.

Possible complications after blepharoplasty:

The most dangerous complication of local anesthesia is an allergic reaction to the components of the drug, which can lead to anaphylactic shock. To avoid this the surgeon and the anesthesiologist examine the patient’s health condition and, if there is a reasonable doubt, conduct a sensitivity test. They can also conduct this test on request of the patient. But even if the test becomes positive, it will be easy for doctors to replace the substance that causes allergy in the patient as there is a large variety of modern anesthetics they can select from.

Puncture of the blood vessel is one of possible side effects of local anesthesia. It will cause the patient to have a burning sensation during the injection. After surgery it may result in bruising. There is also a risk of disturbed breathing. But this complication occurs in patients with a history of serious respiratory function disorders. Local anesthetics are generally contraindicated for such patients.

In summary :

The choice of the particular type of anesthesia depends on whether upper or lower blepharoplasty will be performed. Individual characteristics of the patient's body also contribute to the selection process. Patients themselves can express their preferences for the choice of anesthesia. However, only the plastic surgeon makes the final decision. What patients should remember is that the use of one or another type of anesthesia does not affect the quality of the surgery.The level of the doctor's professionalism is the only thing which matters.