One of the most common questions I get about eyelid surgery is whether the patient can stay “awake” during the procedure. Yes, it is absolutely possible to have eyelid surgery without general anesthesia. The alternative is a combination of intravenous sedation with local anesthesia.
Under intravenous (IV) sedation, patients are completely but lightly asleep during their procedure. They rest comfortably, breathing on their own without endotracheal tubes. There’s no awareness of surgery, yet when the procedure is finished, patients awaken quickly, without grogginess.
The benefits of IV sedation, also called twilight sedation, are numerous. Patients almost never experience an anesthesia “hangover,” and they don’t have to contend with flu-like symptoms of nausea and chills. There’s no sore throat to serve as a reminder of the breathing tube. Finally, there’s the simple pleasure of feeling awake and alert almost immediately after surgery. Remarking on her recent experience, one of our own eyelid surgery patients noted that while she did bring someone to drive her home, she “could have walked out the door and gotten on the train.”
Considering the benefits of twilight sedation over general anesthesia, why don’t more plastic surgeons go this route for eyelid surgery? The main reason is that surgery is a bit easier for the medical team when patients are deeply asleep. There’s no chance a patient will stir, and monitoring vital signs is relatively routine. Plastic surgeons who choose this form of anesthesia often say it allows them to give full attention to the procedure itself.
IV sedation requires the surgical team to work together seamlessly. To ensure the patient remains lightly but completely asleep, the plastic surgeon, anesthesiologist and surgical assistants must communicate frequently and clearly, supporting each other to successfully complete their part of the surgical process. This precision teamwork requires talented staff members who are exceptionally well trained and experienced. And the longer they have worked together as a team, the better.
Plastic surgeons often field questions about the merits of various approaches to cosmetic surgery—whether people are inquiring about tools or techniques. Most medical professionals recommend patients make an informed choice of plastic surgeon and go with what their doctor prefers. This is sound advice. Consistent results are the most important factor, right behind patient safety.
Sometimes there are reasons to seek a particular technique, however, especially when it comes to anesthesia. Some eyelid surgery candidates have experienced a bad reaction to general anesthesia in the past and don’t care to invite a repeat. Other patients have a deep-seated fear of surgery that IV sedation can ease.
If you are considering eyelid surgery and the anesthesia involved is important to you, invest a little extra time in performing research. Find out which plastic surgeons in your area offer IV sedation, then learn as much as you can about the entire surgical team. If you discover that general anesthesia is the only option available where you live, you might consider traveling to work with another plastic surgeon.
