Upper Blepharoplasty: Local Anesthesia or Sedation?

Young asian woman on OR table about to be placed under general anesthesia.


Droopy eyelids don’t just make you look tired, they can also affect your vision. As we get older, skin loses its elasticity and eyelids can begin to sag. But droopy eyelids can also be caused by any illness or condition that affects the nerves or muscles of the eyes such as a stroke, brain tumor or cancer. If you have sagging eyelids that are beginning to alter your appearance or sight, you may want to consider blepharoplasty, also known as an eyelid lift. The procedure will remove excess skin on the eyelid. Afterward, you will notice that your eyes appear more alert, which will give you a more youthful appearance. Blepharoplasty can be performed either on the upper or lower eyelid — or both.

This post will focus on upper blepharoplasty, which pertains to the procedure for the upper eyelid.

What is Upper Blepharoplasty?

As people age, they may start to notice a heavy feeling with their eyelids. There are two main reasons for this:

1. The descent of the eyebrow

2. Extra skin around the upper eyelid area

Sometimes, it can be a combination of both. With an upper blepharoplasty, you can easily get rid of the problem of heavy feeling lids. Note that this procedure is not the same as a brow lift, although Youthful Reflections may perform these two procedures together. 

Upper blepharoplasty can provide benefits that can be for both cosmetic and functional purposes. You can undergo the procedure to reduce signs of aging or to help get rid of or lessen obstruction of your vision due to excess or overhanging skin. Some people opt for the treatment to remove puffiness that may affect their upper lids. 

How is Eyelid Surgery Performed? 

As with any medical procedure, the first step is to meet with an expert such as Dr. Boggess. Make sure that you choose a doctor who has the right experience and who you feel comfortable with. The initial meeting will serve as a consultation to determine whether you are a candidate for the surgery, or not. This discussion is crucial because it will help Dr. Boggess and his team understand your issues and concerns, as well as your goals, and will give them the chance to learn about your medical history. You should disclose if you’ve had procedures in the past, along with a history of any health problems.

After your consultation, Youthful Reflections can schedule a blepharoplasty for you at your convenience. They will also give you specific directions on what to do before and after the procedure, as well as what you can expect. If you have questions or concerns at any time, the facial experts at Youthful Reflections are available to talk with you

During an eyelid lift, your doctor will identify the creases on your upper eyelids and create a very small incision that hides in the natural eyelid crease. The practitioner will then remove the excess skin while making sure the eyelids will function normally. There are some cases, however, when a tiny part of the muscle responsible for closing the eyelids, known as orbicularis oculi, will be removed.

Some patients may have protruding fat in the upper eyelids that create fullness. If this is the case, your doctor may remove it to aid in contouring the eyelids. After the successful surgery, the final step is to close the incisions on the lids with tiny sutures that are hidden in the natural creases of your eyes. Any scars will be hidden in these natural creases so that they are not noticeable. The procedure will typically only take 30 minutes and you can even go home right after.

Which is Better – Local Anesthesia, conscious sedation, or general anesthesia?

Dr. Boggess has been successfully performing eyelid lifts for more than 19 years. One of the most common questions our facial plastic surgery experts are asked is whether the patient will be sedated throughout the surgery. An eyelid lift can safely be performed with local anesthesia, conscious sedation, or general anesthesia.

Local anesthesia is accomplished by injecting local anesthetic medication into the specific part of the body where the surgery is to be performed, causing temporary loss of sensitivity. In the case of blepharoplasty, after the local anesthetic injections, the upper eyelid becomes completely insensitive, or numb, throughout the whole procedure.

Conscious sedation involves using sedative medications that may be administered orally or through an IV to relax the patient during the procedure.  Oral sedation is a light level of sedation in which the patient is relaxed but still likely awake and aware during the procedure. An IV sedation is a deeper level of sedation, where the patient will likely be dozing in and out of sleep during the procedure but remains arousable to vocal stimuli.  Local anesthesia is used in combination with these conscious sedation techniques to locally anesthetize the surgical site so that the patient does not feel discomfort from the procedure.

Youthful Reflections prefers local anesthesia with, or without, conscious sedation for blepharoplasty procedures because it is a safer and more cost-effective alternative to the general anesthesia.

In other practices, blepharoplasty is often performed under general anesthesia. With general anesthesia, the patient will be completely asleep and unaware of the surroundings, and will not respond to any stimuli.  It is Dr. Boggess’ opinion that general anesthesia unnecessarily increases the risk and the cost of the procedure and prolongs recovery. At Youthful Reflections, we have a perfect safety record performing blepharoplasty without the need for general anesthesia.

Dr. Boggess and his team will talk to you about your previous experiences with anesthesia, your preferences, and the risks and benefits of the anesthesia alternatives to make certain the most appropriate anesthesia plan is determined for your procedure.  You will not need to stay overnight at a hospital, because eyelid surgery can be done safely in an outpatient setting.

All in all, an upper blepharoplasty will be a quick procedure. You will likely experience some bruising and swelling, but these side effects will typically resolve in 10 – 14 days. Most people can return to normal activities within one week. 

If you’re interested in receiving an upper blepharoplasty and want to know if you’re a suitable candidate for the procedure, give Youthful Reflections a call today to schedule your consultation!

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