Blepharoplasty under general anesthesia or local anesthesia. What anesthesia is used to perform blepharoplasty? Local anesthesia or general anesthesia

Age-related changes in the eyelids can only be corrected by blepharoplasty - a surgical operation to tighten the skin of the upper and lower eyelids. It is carried out solely for aesthetic purposes, but women are ready to endure the pain and inconvenience of postoperative recovery for the sake of radical rejuvenation.

After forty to fifty years, the only real way to get rid of the problems of age-related aging in the eye area, including lower eyelid hernias, severe wrinkles, and sagging skin, is to undergo blepharoplasty. But in some cases, correction can be carried out at an earlier age. The operation is one of the most popular, because you can visually look ten to fifteen years younger.

Indications for correction

Why is eyelid surgery needed? The essence of the operation is the excision of excess skin and accumulations of fat. They are the ones who make your face look old and tired. Indications for a radical facelift are as follows:

overhang of the skin of the upper eyelid on the area of growth of the upper eyelashes;
lack of a fold in the upper eyelid as a result of severe overhanging skin;
formation of deep wrinkles in the lower eyelids;
the formation of numerous wrinkles under the lower eyelids (“corrugated paper effect”);
deterioration of vision as a result of severe sagging of the upper eyelid;
permanent fat bags under the lower eyelids;
a special structure of the upper eyelid that does not allow the use of cosmetics (natural overhang).

Before plastic surgery, you should check your health, as there are contraindications: blood clotting disorders, oncology, skin diseases, diabetes, hyperthyroidism.

If there are no contraindications, the plastic surgeon will determine the condition of the skin, outline a plan for eyelid correction, conduct a consultation and schedule a day for surgery.

Types of blepharoplasty

What type of lift the surgeon decides to use depends on the specific problem. There are the following types of blepharoplasty:

correction of the upper eyelid;
changing the incision and shape of the eyes (canthoplasty, canthopexy);
correction of the lower eyelid with simultaneous removal of fat accumulations in the intraorbital area:
correction of the lower eyelid without removing fat depots (fat is redistributed over the eyelid area);
simultaneous eyelid correction (circular blepharoplasty).

The surgical intervention is performed either under general medical anesthesia or under local, lighter anesthesia. Both options will not cause trouble, because in both cases there will be no pain.

Features of different types of correction

Upper blepharoplasty

The upper incision is made along the natural crease of the eyelid. The operation allows you to get rid of sagging skin, change the shape of the eyes, for example, carry out correction using the “Cleopatra look” technique. After healing, the seams are almost invisible and can be easily cosmetically disguised.

Lower eyelid blepharoplasty

In the lower eyelid, it is possible to either cut the skin along the eyelash line or penetrate (puncture) through the mucous membrane. In the latter case, we are talking about the transconjunctival method, which only allows the removal of fat bags, and therefore cannot be used in the presence of excess skin and deep wrinkles.

Circular blepharoplasty

Circular blepharoplasty makes it possible to solve several problems at once:

correct drooping upper eyelids and drooping corners of the eyes;
remove fat bags in the paraorbital area;
get rid of wrinkles;
correct the asymmetrical shape of the eyes.

This type of correction is most preferable for comprehensive relief from signs of aging. In combination with other methods of hardware correction (Fraxel, laser resurfacing, etc.) an amazing effect will be achieved that will last up to ten years. The seams are completely invisible.

Preparing for surgery

Eyelid lift surgery takes different times. This depends on whether the surgeon will work only on the upper eyelids, only on the lower eyelids, or on both eyelids at once. In addition, it also matters whether the excision is performed under local anesthesia or general anesthesia. The decision is made before the procedure based on an initial examination of the skin structure, the condition of the facial muscle corset, the structure of the skull bones, the presence of asymmetry, etc. It is necessary to understand how much skin and fatty tissue will have to be eliminated.

When deciding on anesthesia, it is important to inform your doctor about the facts of an allergic reaction, especially to medications and painkillers. Together with the client, the specialist will decide how the plastic surgery will be performed: under general anesthesia or local anesthesia.

Important: before surgery, no salon cosmetic procedures are allowed.

The doctor must find out how much tear fluid is produced, for which he will conduct a special examination before the operation. It is necessary to promptly report existing eye diseases, for example, glaucoma or dry eyes. It is important to talk about the presence of chronic diseases (diabetes, dysfunction of the thyroid gland, hematopoietic organs, etc.) - all of these are contraindications for eyelid surgery. If the client is taking any medications or herbal remedies, he should tell the doctor about it. All this will help prevent dangerous bleeding during surgery.

After the examination, the surgeon is obliged to talk about the possible consequences of the surgical intervention, since there are cases of atypical skin reactions both to anesthesia and to the effect itself. At the same time, he will explain what results should be expected after the stitches heal and prescribe tests.

Preparation period

Before the operation, the client must go through a certain preparatory period:

drink a lot of water to ensure quick successful rehabilitation (you will have to drink water even after the operation is completed);
completely give up nicotine, otherwise tissue regeneration will be very low and rehabilitation will be delayed;
Avoid taking aspirin, anti-inflammatory, homeopathic medications, vitamin complexes not only on the day of surgery, but also three to four days before (they provoke bleeding, why risk it).

Local anesthesia or general anesthesia

If the operation is performed under local anesthesia, general tests such as blood chemistry, blood clotting tests (coagulogram) and the presence of infections will be required. You can get advice from a therapist and a specialist if you have a chronic illness.

If the operation is complex and is carried out under general anesthesia, then you will need not only to undergo tests, but also to undergo an ECG procedure, take a fluorography or take an x-ray of the sternum, and attend a consultation with an anesthesiologist.

The choice between local anesthesia and general anesthesia is simple. If we are talking about circular plastic surgery, anesthesia is needed, because the time of exposure to tissue and mucous membranes increases. In addition, it is not painful at all, whereas under local anesthesia there may well be unpleasant sensations. If the surgeon is only working on the bottom or top of the eyes, local anesthesia can be used.

The operation is performed on an outpatient basis. After plastic surgery, the client must go home, but a loved one must be with him for the first 24 hours.

How is the operation performed?

Before the operation, the surgeon uses a special marker to mark the area to be treated, then injects an anesthetic (this may be painful). If the operation is performed using the traditional surgical method, then a thin incision is made with a scalpel in the skin or in the mucous membrane of the lower eyelid (for transconjunctival plastic surgery).

Unnecessary tissue and fat bags are excised through incisions. The surgeon can simultaneously tighten the muscles and strengthen them. Sometimes the fat is not removed, but is redistributed under the lower eyelid.

The seams are sewn together with special threads, which, when absorbed, do not leave scars: the seams will be invisible. In some cases, the surgeon will also use a laser (which is not painful at all) to improve the condition of the skin. After restoration, grinding can be done.

Rehabilitation period

After the operation, it will take time to return to normal life and enjoy the effect that eye blepharoplasty gives. In advance, before going to the clinic, you need to prepare the following items:

ice cubes;
gauze napkins;
pharmaceutical preparations for the eyes (the surgeon will prescribe them on the eve of the operation);
painkillers or injections (some can cause bleeding, so it’s best to ask your doctor for a list of acceptable medications):
the surgeon will tell you in detail how to do drainage and dressing (if necessary), which antibiotic to take.

The first time after surgery will be difficult for the eyes: they will begin to react more strongly to light, profuse lacrimation will appear, and double vision may occur. For the first two to three days, the stitches will stand out, swelling will appear, and numbness may persist - the consequences of local anesthesia or anesthesia. This is a normal reaction.

How long the swelling and hematomas last depends on the sensitivity of the skin. On average, recovery occurs on the seventh to tenth day. It shouldn't hurt, but there may be discomfort. You can apply ice compresses and take painkillers.

Under no circumstances should you take aspirin or naproxen. Taking ibuprofen and herbal supplements is prohibited.

Usually on the third or fourth day, pain relief is no longer necessary.

Removing stitches

On what day are stitches removed? The doctor will schedule the first consultation on the third postoperative day. If all is well, the stitches are removed. It doesn't hurt at all. If something alerts the doctor, he will advise you to wait a little longer, in which case the stitches are removed on the fourth day.

If your eyelids are very painful, there is swelling, redness, or the sutures are inflamed, you need immediate consultation with a surgeon.

Is blepharoplasty necessary?

Keeping in mind possible complications both during and after the operation, the question arises: is correction really necessary? If blepharoplasty is contemplated, only the patient himself can analyze the pros and cons in order to make the right decision.

Pros of the operation

bags under the eyes will completely disappear;
it won't hurt;
the look will become younger and open due to the correction of the upper eyelid;
in some cases, vision will improve (there are medical indications);
the seams are invisible.

Cons of exposure

results may not be seen immediately (at least on the thirtieth day, or even after one and a half to two months);
long recovery period accompanied by discomfort;
in some cases, a second operation will be required if there are deep wrinkles on the forehead;
plastic surgery may not be successful, there will be no result.

Complications

You should not discount the complications that such a surgical procedure can cause:

allergy to an anesthetic drug;
hematoma formation;
inflammation as a result of infection;
scarring of tissue;
formation of an inverted lower eyelid.

There are no medical indications for blepharoplasty, so you can make decisions on your own. What it will become depends only on the woman’s desire to become younger, more beautiful, remove bags and wrinkles, and look ten years younger.

Despite the fact that in recent years general anesthesia has become extremely safe and comfortable, patients are always happy to choose other, less profound options for pain relief.

Unlike most plastic surgeries, Blepharoplasty can be performed under local anesthesia, when the anesthetic effect affects only the area around the eyes, and the patient remains conscious. A full-fledged eyelid lift as an outpatient procedure certainly looks attractive - however, it has its own nuances and pitfalls that you should know about in advance.

So, does this method have objective advantages or disadvantages? In what cases is it indicated and in what cases is it not? What medications are used and how is the operation performed? The site goes into detail:

How do they do it?

It is not possible to do without general anesthesia during blepharoplasty in all cases. This is only possible if a technically simple small-scale operation is planned - for example, isolated correction of the upper eyelids - and the patient himself is mentally ready to endure it, being fully conscious. At the same time, local anesthesia has obvious advantages:

minimal likelihood of developing complications associated with the action of more “heavy” drugs for general anesthesia;
the ability to open and close the eyes on command, which greatly simplifies the operation for the surgeon and reduces the likelihood of under- and over-correction;
The hospital stay at the end of the intervention is limited to a few hours, after which you can immediately go home. All subsequent manipulations (observation, removal of sutures) are performed at an outpatient appointment.

So there are some disadvantages:

in the absence of general anesthesia, and also due to inevitable nervous tension, the patient’s blood pressure will be quite high - this does not threaten health, but may interfere with the surgeon (in addition, many doctors, in principle, prefer to work with “sleeping” patients);
there remains a small probability of allergic and other undesirable reactions to injected drugs.

There are two ways to turn off pain sensitivity without putting a person to sleep:

Application - an anesthetic cream or spray is applied to an area of skin, and after a few minutes it becomes “numb”. The main disadvantage of this option is that the effect practically does not affect the subcutaneous fat and muscles, so it is used only for minimally invasive procedures, such as or.
Injection - when the anesthetic is injected using a syringe with a thin needle. In this case, it will penetrate into much deeper layers of skin and tissue, and in addition, it will act much longer.

For eyelid surgery, only the second (injection) method is used. Specific drugs can be very different; they are selected by a surgeon or anesthesiologist “for the patient.” As a rule, these will be products based on lidocaine, ultracaine and bupivacaine. But novocaine, popular among cosmetologists, is not suitable due to its short duration of action.

Features of the operation under local anesthesia

Regardless of the type of anesthesia chosen, the preparatory stage will be approximately the same: the patient must undergo a standard set of tests, temporarily give up alcohol, smoking and a number of medications. In addition, his allergic and anesthesiological history is necessarily studied: whether operations were performed in the past, what kind of anesthesia was used and whether it led to any undesirable consequences, whether there is intolerance to certain drugs, etc. – this is necessary to exclude the possibility of anaphylactic shock and other serious complications.

Immediately before the operation begins, the areas where the lift will be done are marked on the skin of the eyelids with a special marker. Next, the entire face is treated with an antiseptic, injections are given to “turn off” sensitivity, and when they take effect, the surgeon begins work.

Many people are concerned about the question: will they feel pain during eyelid surgery if they choose local anesthesia?

During the injections themselves, you will have to be patient: they are extremely uncomfortable, since the anesthetic drug is injected quite deeply and at the same time into a very sensitive and delicate area near the eyes.
Further, during the operation, there will be no pain, but patients can feel the pressure of surgical instruments and the movement of threads during suturing - much the same as we feel the dentist’s manipulations inside our teeth and gums. In addition, you will have to look at the bright light of surgical lamps, and when using a laser scalpel, you will also have to smell the smell of burnt meat. For many, such sensations cause nervous tension and other unpleasant reactions, so local anesthesia is almost always supplemented with oral sedatives - they bring the person into a calmer, sleepy state.
For people with a very low pain threshold and/or increased anxiety, intravenous sedation, during which consciousness is completely switched off, may be indicated instead of oral sedation. Subjectively, this option is not much different from general anesthesia: the only difference is in the dosages of the drugs and the possibility of spontaneous breathing.
The intensity and duration of local anesthesia depends on the amount of the drug administered, its concentration, as well as the individual characteristics of the human body. It happens that right during the operation, the effect of the anesthetic weakens and sensitivity begins to return. This must be reported to the surgeon so that he can make an additional injection.

Upon completion of the plastic surgery, the patient is taken to the ward to monitor his condition for 2-3 hours. If no problems arise at this stage, painkillers are prescribed in the form of tablets or intramuscular injections (analgin, ketanov, paracetamol), after which you can go home.

Possible complications and side effects

The most formidable negative consequence of local anesthesia, which everyone has heard of at least once, is an allergic reaction leading to the development of Quincke's edema and anaphylactic shock, which directly threaten the patient's life. Fortunately, this happens extremely rarely - about 1 problem case per 15,000 successful operations (0.01%), which even according to the strict canons of aesthetic surgery is considered a relatively acceptable risk.

To completely eliminate the possibility of such negative reactions, the surgeon or anesthesiologist, firstly, carefully examines the health status and individual characteristics of the patient before the operation, and secondly, they can conduct additional tests for sensitivity to the drugs that are supposed to be used for pain relief. Even if it turns out that one or more of them actually cause an allergy, you can almost always find a safe replacement for them. Normally, such a test is carried out only if there are any reasonable concerns, but it is also possible simply at the request of the patient. Other undesirable consequences of local anesthesia include:

Possible problems with spontaneous breathing - they threaten only patients with serious pathologies of respiratory function; as a rule, local anesthetics are contraindicated for them in principle.
Puncture of a vessel: manifested by a burning sensation that occurs during an anesthetic injection, slight swelling and redness, and later a bruise may form in this place.
Other problems associated with injections as a method of delivering painkillers into the body: infection, hematomas, increased swelling. But in the vast majority of cases, these “side effects” do not pose a serious danger and do not require any special attention against the background of the main consequences of eyelid surgery.

What to remember

The choice between general and local anesthesia during blepharoplasty is made depending on the volume of the operation, which particular pair of eyelids - upper or lower - is being worked on, as well as the individual characteristics of the patient. Your wishes regarding anesthesia can be discussed during the consultation, but the final decision is made by the surgeon based on his professional knowledge. Wherein:

The final quality of the operation and its aesthetic effect do not depend in any way on which option is used.
Under local anesthesia, discomfort is partially preserved. In addition, looking at the surgeon’s work while conscious can be psychologically difficult, and it is impossible to visually isolate the surgical field (the eyelid area) from the patient. Therefore, in the vast majority of cases, additional sedatives are also used - orally or intravenously.
Even if you cannot do without general anesthesia, you should not panic again. Most of the information about its severity dates back to the end of the last century and is very outdated: modern drugs provide restful sleep, minimal risk of complications, as well as a cheerful, healthy state upon awakening - without nausea, dizziness and other unpleasant symptoms.

Experts' opinions:

I try not to do blepharoplasty under local anesthesia, only in rare cases when there is not a large volume of work - for example, if I need to remove part of the skin without delving into the deeper layers of tissue, a hernia.

Plastic surgeon, candidate of medical sciences

This type of anesthesia is used primarily if a small amount of surgical intervention is planned. At the same time, I always take into account the patient’s wishes, his emotional background and physiological reactions to stress. Naturally, a decision in favor of local anesthesia is also made in case of contraindications to general anesthesia. In general, the choice of pain relief method depends on a number of factors:

volume and duration of the proposed operation;
the patient’s physical condition and age;
psycho-emotional state;
presence of allergic reactions, etc.

Both options have their pros and cons. The most important thing is to take into account the characteristics of a particular patient.

Plastic surgeon, Doctor of Medical Sciences

Any blepharoplasty can be performed under local anesthesia. Its advantages are that the patient is always fully conscious and can go home immediately after the operation. Disadvantages: since all manipulations are carried out near the eyeball, for some it causes very unpleasant sensations. As a rule, men prefer general anesthesia, and women prefer local anesthesia.

Anastasia (40 years old, Moscow), 04/12/2018

Hello, dear Doctor! I am writing to you to get a qualified answer. My name is Anastasia, I am 40 years old. Recently, my friend had eyelid surgery, thereby making her look several years younger. I was also very excited about this idea, talked to my husband and he agreed. But, I am concerned about the issue of money. I looked at the prices on your website, but will I need to buy any additional ointments for the eyelids after the operation? If necessary, then which ones? And what is their price? Thank you!

Good day, Anastasia! After blepharoplasty, you must use a regular night cream for the skin of the lower eyelids. The upper eyelids do not need active moisturizing with special means. Sincerely, plastic surgeon Maxim Osin.

Alexander (44 years old, Moscow), 04/05/2018

Hello, Maxim Alexandrovich! Are there any special rules that must be followed after blepharoplasty? I've heard about reducing physical activity, for example? Sincerely, Alexander.

Hello, Alexander! Indeed, during the rehabilitation period (which usually lasts from one and a half to two months), it is advisable to refrain from an active lifestyle and intense physical activity. This is due to the fact that failure to comply with these requirements can lead to pressure fluctuations, which affect healing. Additionally, there may be individual factors that need to be considered during the rehabilitation process.

Maria (18 years old, St. Petersburg), 03/28/2018

Good afternoon, my name is Maria, I'm 18 years old. Not long ago I had an accident, I had stitches and now one eyelid is drooping over my eye. Please tell me what correction can be used to solve this problem? Thank you in advance.

Hello Maria! To assess the extent of the problem, it is advisable to see you at a face-to-face consultation, or send your photo to me by email. If you have ptosis of the upper eyelid, then blepharoplasty will cost around 50 thousand. If only tissue scarring is observed, then about 30 thousand.

Daria (37 years old, Moscow), 03/13/2018

Hello! Tell me, are the swelling and bruises noticeable after? How soon can I be discharged from the hospital?

Hello! Swelling and bruising after this surgery usually goes away within 7-14 days. If you were admitted to a hospital after the operation (although you may be sent home immediately), you may be discharged within 1-3 days - the decision is made by the surgeon who performed the operation. Good luck to you! Thanks for the question!

Violetta (41 years old, Korolev), 06/04/2017

Hello, Maxim! Due to genetic characteristics, I have very sagging eyelids. It's the same with my mom. I want to have eyelid surgery, but I don’t know how difficult it is to prepare for surgery. Could you tell? Violet.

Good afternoon, Violetta. We always start the examination with an initial in-person consultation and passing all the necessary tests (the list can be requested from the administrator of our clinic). 3 weeks before plastic surgery, I strongly recommend giving up smoking, alcohol and medications containing aspirin. You need to rest before the operation itself. Sincerely, plastic surgeon Maxim Osin!

Olga (37 years old, Moscow), 06/03/2017

Good afternoon, Maxim Alexandrovich! My name is Olga, I am 37 years old. I really want to have blepharoplasty on my eyelids. Tell me, how long does the result last?

Good afternoon, Olga. The result after eyelid surgery can please you for many years (from 7 to 10 years). The only thing you must remember is that eyelid surgery does not reduce the natural aging of the skin. Sincerely, plastic surgeon Maxim Osin!

Alexandra (58 years old, Moscow), 06/01/2017

Hello! Please tell me how long after eyelid surgery I can calmly take a shower and wash my hair? Will I have to wait 2 weeks? Until the rehabilitation time passes?

Hello! Of course not! The very next day after eyelid surgery, you will be able to take a shower and wash your hair. The main thing is to thoroughly dry your head and seams after water procedures. The stitches will be removed approximately the fourth day after surgery. But you can use cosmetics after eyelid surgery only for 7-10 days. Sincerely, plastic surgeon Maxim Osin!

Angelina (44 years old, Moscow), 05/30/2017

Good afternoon I'm getting ready for blepharoplasty. I am 44 years old. Tell me, how long will it take for me to see the results of eyelid surgery? How long will the swelling last? When can you be sure how successfully everything went?

Hello! I recommend assessing the results of eyelid surgery two weeks after surgery. Swelling will persist for the first three days after surgery. Only after 10 days will your bruises completely disappear. The scar will become invisible after 1.5-2 months. Then we can talk about the final result of the operation. Sincerely, plastic surgeon Maxim Osin!

Adequate pain relief during eyelid surgery is necessary to ensure patient comfort and minimize any discomfort associated with making incisions and suturing soft tissue. Many patients are interested in the approach to pain relief: what anesthesia will be used and whether it poses a danger, for example, in case of allergies, as well as which anesthesia is best to choose for themselves.

How is anesthesia performed during eyelid surgery (what anesthesia is used in blepharoplasty)?

There are three possible pain relief options:

Local administration of anesthetics;
Intravenous administration of painkillers and agents with a relaxing and sedative effect. These two methods can be combined with each other.
General inhalation and intravenous anesthesia with complete “switching off” of consciousness.

For local anesthesia, anesthetic is injected to varying depths of the skin and subcutaneous tissue. As a result, the areas where the incisions will be made are saturated with the drug. This leads to a temporary disappearance of pain sensitivity in the desired areas.

Intravenous anesthesia provides an excellent opportunity for the patient to feel completely relaxed, get rid of the fear of the operation process itself, but at the same time be able to answer the doctor’s questions or evaluate the aesthetic result of the intervention at any time. The right combination of drugs and careful selection of dosage can achieve the effect of shallow sleep. As a result, the process of the operation itself is forgotten and there are no unpleasant associations associated with it.

The use of inhalational anesthetics together with intravenous anesthesia is used for large-scale plastic surgeries with a long duration, where correction of the shape of the eyelids is only one of the components.

To accurately answer the question of what anesthesia is used to perform blepharoplasty, it is necessary to take into account the complexity of the operation, the patient’s health status and his attitude towards various types of surgical interventions (for example, a tendency to fear and panic attacks), as well as his wishes and allergic history. Only after all these factors have been taken into account will the attending doctor, together with the anesthesiologist, decide which anesthesia for eyelid surgery is best to use in your case.

Pain relief for blepharoplasty: which anesthesia to choose?

The decision must be made together with the doctor. He will tell you about the expected duration of the operation, find out your wishes, and find out about the presence of concomitant diseases and allergies.

Those who are afraid of the very fact of surgical intervention and want to simply fall asleep and wake up when it is already done can give preference to intravenous anesthesia with the use of painkillers and sedatives. In this case, the specialist uses a combination of long- and short-acting anesthetics, which allows the anesthesia effect to remain for some time after the operation.

What anesthesia is used to perform blepharoplasty for allergies?

You must tell your doctor in advance about the presence of an allergy, especially about such facts of its manifestation as swelling. You can also undergo allergy tests for certain types of anesthetics (lidocaine, bupivacaine, etc.) in advance. When the doctor gets acquainted with the results of such hypersensitivity tests, he will select the safest combination of drugs that can be used for anesthesia in your case.