Is it possible to have upper and lower eyelid surgery successfully without a general anesthetic?
It's clear as day that I really need both upper and lower eyes done! Is it possible
for them to be done successfully without a general anesthetic? (I'm terrified of those!)
Secondly, is it better for the bottom lid to be done by cutting on the outside of the
eye or on the inside of the eye?
Thank you for your question!
You submitted a photo which shows what appears to be upper eyelid extra skin as well as puffiness
under the eye. And your question has two parts: one is regarding is whether or not it is possible
to do eyelid surgery without general anesthetic and you mentioned about being terrified of
general anesthesia. And two, whether or not it is better to do the lower eyelid surgery
from the outside or the inside.
Well, let me first start by answering your first question with an emphatic yes. Yes,
it is possible to do upper and lower eyelid surgery without general anesthesia. Approximately
20 years ago when we started our practice, I became really committed to the idea of avoiding
general anesthesia as much as possible for cosmetic surgery. at this point in our practice,
we actually do everything with the exception of complex rhinoplasties where we do everything
under local anesthesia with LITE™ sedation. You see, I realized during my training that
much of the issues with the healing process and the recovery had to do more from recovering
from general anesthesia than the actual surgery itself. So I made it my mission to prove that
we can do upper and lower eyelid surgery as well as face lifting surgery under local anesthesia.
So I appear in several TV programs and I actually performed the surgery with the patient wide
awake. So you can have eyelid surgery under local anesthesia or in our practice, we do
everything under local anesthesia with LITE™ IV sedation. That means intravenous. You’re
not under general anesthesia, you avoid the tube in your throat but actually, you just
have an IV or intravenous where you get low doses of medication that relax you but does
not require that you have any type of breathing support.
Now as far as the question about the lower eyelid surgery, it actually requires a physical
exam but I’ll tell you a little about how I make the assessment in my practice. I’ve
been a practicing oculofacial plastic surgeon for 20 years and so, I can let you know what
are the details that are important to me when I make an assessment. The first I question
if whether or not to the surgery from the outside or in the inside or whether or not
it appears to be extra skin. There’s a lot of plastic surgeons, board certified plastic
surgeons who get themselves in trouble because they fail to distinguish extra skin from skin
quality or lack of skin quality. So it’s a different enunciation of quantity versus
quality. When people complain that their skin looks crepey or when they smile, there’s
a lot of extra skin, a lot of well-meaning doctors would take away skin and unfortunately,
that results in very often in problems in ectropion where the eyelid everts out or eyelid
retraction where the eyelid is pulled downwards or combinations of both. So determining whether
or not there’s extra skin also determine the integrity of the muscle called the orbicularis
muscle or the lateral canthal tendon which is a tendon that supports the eyelid.
A lot of times when I do this procedure, when there is a little bit of extra skin, I combine
a transconjunctival approach which from the inside of the eyelid with a skin pinch or
a removal of a small amount of skin. It’s very important to understand that eyelid surgery
is not about wrinkles. When we’re dealing with skin quality, we often do procedures
such as fractional CO2 laser, platelet-rich plasma which is using your own blood using
the growth factors that can be separated to stimulate your own body’s collagen. When
you think about what causes reduction in skin quality and crepiness, it’s loss of blood
supply and collagen. So we have been very innovated in way in order to use platelet-rich
plasma to help the skin quality.
So I would say, making that decision does require a physical exam. The majority of procedures
that I perform on lower eyelids, I do use a transconjunctival approach. Transconjunctival
means going from the inside to approach the issues of prolapse of fat and repositioning
and things like that. If there is any laxity with the lateral canthal tendon, we do procedures
such as lateral tarsal strip, lateral canthoplasty, or things to reposition so that the eyelid
doesn’t pull down.
So as far as the two question are concerned, to summarize, you can do a procedure under
local anesthesia or local anesthesia with LITE™ sedation and avoid general anesthesia.
I would really advocate on that. I feel that my patients recover a lot faster. We get most
of our patients back in a week and as far as the eyelid surgery is concerned, it really
requires a physical exam to determine the indications going from the inside to the outside.
In skilled and experienced hands, either technique is valid. So it’s more matter if what is
right for you. So at this point, I would recommend meeting with qualified and experienced cosmetic
surgeons. I would also suggest that you meet with people who have a lot of experience with
eyelid surgery and can understand the complexities of other procedures necessary to maximize
the outcome and to avoid the problems I refer to earlier and once you meet and get a sense
of what the approach is and you feel confident, move forward. So I hope that was helpful,
I wish you the best of luck and thank you for your question!