What type of anesthesia is right for my eyelid surgery?

By Joseph Walrath, MD | Aug 4, 2014 | Blepharoplasty, Eyelid Malposition

For “standard” eyelid surgery, I find that the level of anesthesia can usually be decided on between the patient and myself.  From April 2014 thru June 2014, I performed 155 major surgical cases, of which 140 were eyelid surgeries (the rest were eye socket or tear drain surgeries). The distribution of anesthesia chosen for these cases is listed below:

Local anesthesia (office surgery): 12%

Monitored anesthesia (twilight): 77%

General anesthesia: 11%

My personal rule of thumb is that if the procedure is a cosmetic reconstruction and “complex”, then the patient is best suited for some level of sedation.  On the other hand, if the case is about an hour or less in duration and is expected to be “standard” in complexity, than it could be done with as little as a series of office injections and a mild oral sedative. Oral sedation or twilight sedation have the advantage of allowing the patient to return home faster after the procedure, with less side effects from the anesthesia. However, in cases with patient anxiety or if certain types of hardware or instrumentation are required, then general anesthesia is preferred.

If the patient chooses to have any level of alertness (twilight or office) during the procedure, the patients generally have a good experience, as manifested below, in which a patient wanted to commemorate his freshly completed upper eyelid surgery with a  team photograph!


I find that office surgery is similarly enjoyable, for both myself and the patient, and affords the opportunity for comfortable interaction with good conversation and good music, with no compromise in the quality of the surgery.

Nevertheless, there are certain elements that lead me to favor general anesthesia:

– The multi-operated eyelid

– Anticipation of extensive scar release

– Anticipation of the requirement for drills or other hardware

– Long surgeries, e.g. more than 2.5 hours

– Upper and lower blepharoplasty combined in selected patients

– Absence of medical contraindications for general anesthesia

Just as all surgeries are individualized to the patient, so is the choice of anesthesia.  This is a topic for discussion with every patient that I operate on.