Blepharoplasty, also known as eyelid surgery, is a cosmetic procedure that aims to improve the appearance of the upper and lower eyelids. It can involve removing excess skin, muscle, and fat to smooth bags and wrinkles around the eyes. While blepharoplasty is often performed under general anesthesia, it is possible to have this surgery while awake under local anesthesia. There are advantages and disadvantages to having blepharoplasty awake that patients should consider when deciding on the right anesthesia approach for them.
What is blepharoplasty?
Blepharoplasty, commonly called eyelid surgery, is a plastic surgery procedure that alters the upper and/or lower eyelids. The goal is to improve vision obstructed by excess skin or correct a cosmetic issue like bags under the eyes, droopy eyelids, or wrinkles around the eyes. Blepharoplasty can involve:
- Removing excess fat, muscle, and skin from the upper eyelids
- Reducing puffiness and bags under the eyes by repositioning or removing fat below the eyes
- Tightening and smoothing the area around the eyes
This surgery can be performed on the upper lids, lower lids, or both. It can help restore a more rested, youthful appearance to the eye area. But it also serves functional purposes like expanding peripheral vision obstructed by sagging upper eyelids.
Candidated for blepharoplasty
Ideal candidates for blepharoplasty include:
- Adults with excess upper eyelid skin that impairs peripheral vision
- Those with excess fat and skin of the lower eyelids causing a baggy appearance
- People with droopy upper eyelids making them look tired or sad
- Individuals bothered by wrinkles and creases around their eyes
Candidates should be in overall good health without any eye diseases or thyroid disorders. They should also have realistic expectations about the surgical results. While blepharoplasty can improve certain eye concerns, it cannot erase all signs of aging or fatigue.
How is blepharoplasty performed?
Blepharoplasty is an outpatient procedure lasting 1-3 hours depending on the extent of the surgery. The surgeon will mark the surgical sites around the eyes and administer anesthesia. This may be local, IV sedation, or general anesthesia depending on patient preference.
Upper blepharoplasty
During upper blepharoplasty, an incision is made in the natural upper eyelid crease. The surgeon trims excess skin, muscle, and fat through this incision. They may also reposition the fat over the eyeball to smooth bulges. The incision is then closed with absorbable stitches.
Lower blepharoplasty
There are a few techniques to access the lower eyelid during surgery:
- Transconjunctival blepharoplasty – The incision is made inside the lower eyelid to avoid an external scar.
- Subciliary blepharoplasty – The incision is made just below the lash line.
- Infraorbital blepharoplasty – The incision goes directly below the lower lash line in the eye’s orbital rim.
Through these incisions, excess fat is trimmed or repositioned. Excess skin can also be reduced. The incisions are closed with absorbable sutures.
After surgery, the eyes will be lubricated with ointment. Patients should avoid strenuous activity for about two weeks. Most visible bruising and swelling resolves within 14 days, but subtle swelling may persist for months.
Can you have blepharoplasty awake?
Yes, blepharoplasty can be performed while the patient is awake using local anesthesia. This involves injecting a numbing medication like lidocaine around the eyelids and surgical sites. Patients remain fully conscious but do not feel any pain during the procedure.
Advantages of awake blepharoplasty
There are some potential advantages to having eyelid surgery while awake:
- Faster recovery – Being awake avoids risks of general anesthesia like breathing problems, nausea, and drug reactions. There is typically less postoperative lethargy.
- Less bruising – Remaining upright during surgery can reduce bleeding, swelling, and discoloration.
- Better results – The surgeon can assess symmetry and fine-tune results while the patient is awake.
- Convenience – Local anesthesia avoids IVs and intubation. Patients can usually drive themselves home after.
- Cost – Eliminating general anesthesia fees reduces the overall cost.
Awake blepharoplasty with just local numbing can be a good option for less complex cases focusing on the upper lids only. Patients with anxiety about being sedated during surgery may also prefer being awake.
Disadvantages of awake blepharoplasty
However, there are also some downsides to conscious eyelid surgery:
- Discomfort – Some tugging or pressure may be felt during surgery despite anesthetic.
- Need to lie still – Patients must keep their head still during the procedure, which can cause neck strain.
- Potential anxiety – Being awake could increase nerves about hearing or smelling during surgery.
- Difficulty assessing lower lids – Moderate sedation is sometimes needed for lower blepharoplasty.
- Duration – Local anesthesia may wear off if surgeries exceed 2-3 hours.
Patients worried about pain or keeping still for an extended upper and lower blepharoplasty may wish to choose sedation or general anesthesia. Individual factors like anxiety level and pain tolerance play a role.
What to expect during awake blepharoplasty
Here is a general overview of what to expect with awake blepharoplasty:
Before surgery
Preparation typically involves:
- Avoiding blood-thinning medications like aspirin for 1-2 weeks pre-surgery
- Arranging a ride home and caregiver for the first 24 hours
- Fasting for 8-12 hours before surgery
- Washing the face and removing all cosmetics before arriving
Anesthesia
The anesthesiologist will clean the areas around the eyes then inject local anesthetic like lidocaine. This numbs the eyelids and surrounding tissues. Minimal IV sedation may be used for patient comfort, but not enough to put the patient fully asleep.
During surgery
The patient reclines on the operating table and remains conscious during surgery. They are covered with surgical drapes so only the eye area is exposed. The surgeon makes small incisions and alters the eyelids as planned. Patients may experience some pressure but no pain due to the local anesthetic. Upper and lower lids are typically operated on separately. The procedure takes 1-3 hours depending on the extent.
After surgery
Postoperative steps involve:
- Applying antibiotic ointment to the incisions
- Placing cold compresses on the eyes to reduce swelling
- Wearing dark sunglasses immediately after surgery
- Having someone monitor the patient for a few hours after surgery
- Using prescription eyedrops or ointments as directed
- Taking oral pain medication if needed
- Keeping head elevated while sleeping
- Avoiding strenuous activity for 7-14 days
Stitches are typically absorbed by the body over time. Most bruising and swelling resolves within 2 weeks.
Results and recovery from blepharoplasty
After blepharoplasty, patients notice an immediate improvement in their eyelid appearance. However, final results are not seen for several months after surgery as swelling dissipates. Common outcomes include:
- Smoother, tighter upper eyelids with reduced sagging
- Less bulging fat pockets under the eyes
- More open, alert eyes due to lift of sagging lids
- Reduced wrinkles and creases on upper and lower lids
- Enhanced peripheral vision previously obscured by droopy lids
Most patients can return to non-strenuous work or school after about a week. Exercise and other strenuous activity should be avoided for 2-4 weeks. Complete healing takes 6-8 weeks.
Proper aftercare and wearing sunglasses can help reduce visible bruising. Scars from incisions fade significantly over time. Continued use of sunscreen helps maintain results. Effects of blepharoplasty can last 7-10 years or longer before some sagging recurs.
Risks and complications
Blepharoplasty is generally safe when performed by a qualified plastic surgeon. However, potential risks include:
- Bleeding and bruising
- Infection
- Adverse reaction to anesthesia
- Damage to eye muscles or nerves
- Asymmetry between eyes
- Dry eyes or difficulty closing eyes
- Scarring from incisions
- Need for revision surgery
Risks are reduced when blepharoplasty is limited to the upper lids only. Lower lid surgery has a higher risk of complications. Following all postoperative care instructions can also minimize risks.
Cost of awake blepharoplasty
According the American Society of Plastic Surgeons, the average cost of blepharoplasty is:
- Upper eyelid surgery: $3,077
- Lower eyelid surgery: $3,515
- Both upper and lower: $6,592
Location, surgeon fees, and extent of the surgery impact the overall price. Awake blepharoplasty with just local anesthesia tends to be more affordable than procedures requiring general anesthesia or IV sedation.
Some of the factors that affect the cost of awake blepharoplasty include:
- Geographic location – Prices are typically higher in major metro areas
- Surgeon’s expertise and credentials – Board-certified surgeons often charge more
- Office facility fees – Cover operating room costs and equipment
- Anesthesia fees – Local anesthesia costs less than general anesthesia
- Complexity – Combining upper and lower lids is more expensive
- Amount of fat/skin removed – Large reductions cost more
Many patients choose to finance their blepharoplasty through low-interest medical credit cards or personal loans. Some practices offer payment plans as well. This allows patients to budget for the procedure over time.
Is awake blepharoplasty covered by insurance?
In general, blepharoplasty performed solely for cosmetic reasons is not covered by health insurance. However, blepharoplasty may be covered if excess upper eyelid skin severely impairs vision. Documentation of functional impairment from a doctor is usually required.
Functional blepharoplasty of the lower lids is rarely covered. An upper lid blepharoplasty combined with a cosmetic lower lid blepharoplasty is generally not covered by insurance either.
Finding an experienced surgeon
Choosing a qualified, experienced plastic surgeon is essential for safe blepharoplasty with beautiful results. Key tips for finding a skilled blepharoplasty surgeon include:
- Look for certification from the American Board of Plastic Surgery or American Board of Ophthalmology
- Select a surgeon who has completed an oculoplastic surgery fellowship
- Choose a surgeon with extensive blepharoplasty experience and photos of results
- Read online reviews about the surgeon’s bedside manner and results
- Schedule a consultation to evaluate comfort level with the surgeon
- Ask about their approach to awake blepharoplasty specifically
The consultation visit is a chance to assess the practice, ask questions, and determine if the surgeon is a good match. Board-certified surgeons with hospital privileges generally provide greater safety and expertise.
Conclusion
Blepharoplasty performed while awake under local anesthesia can offer certain benefits like faster recovery, reduced costs, and immediate visible results. However, awake surgery may not be ideal for complex cases involving the lower lids or surgery expected to exceed 2-3 hours.
Patients interested in awake blepharoplasty should thoroughly discuss risks and benefits with their surgeon. Realistic expectations about discomfort, recovery time, and results are necessary. Following all pre and postoperative instructions can help minimize risks and achieve optimal outcomes after eyelid surgery. With an experienced, qualified surgeon, awake blepharoplasty can effectively rejuvenate the eye area with relatively quick healing.
