Blepharoplasty

Anesthesia Implications

Position: Supine, arms tucked, Bed turned 90 degrees
Time: 1-2 hours (average)
Blood Loss: Very Low (5-10 ml)
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: No

Approach – Local injection, MAC, with nasal canula.

Prepare the Patient – Start with 0.5-2mg versed in preop. 25-100mcg fentanyl while putting monitors on the patient so it has time to work before the surgeon injects the local. Or you can use alfenta!

Antibiotic – The surgeon will typically request 2-3 grams of cefazolin before procedure start.

Sedation Start – The surgeon will begin by injecting local along the eyelid, can be 1-2 minutes of injecting so make sure patient is pretty sedated for this part. A common approach is to push a few milliliters of propofol at this junction. The surgeon will complain if the patient is squeezing their eyes shut, which will be a natural reaction if there isn’t enough sedation onboard. Depending on the patient, propofol 20- 60mg is typically sufficient.

Sedation Maintenance – Either start a propofol drip or just hand push. Tread lightly because it can be tricky to manage the airway with the bed turned away from you. If you get the patient deep enough before the patient is prepped you can put an oral airway in. If the patient begins desaturating, tell the surgeon to stop while you handle it or ask for assistance to give the patient a jaw thrust (some are comfortable doing this).

Possible Surgeon Requests – There may be a request for IV decadron administration at the beginning of the surgery.

Tucked Arms (general considerations): Consider a second IV – once the procedure has started, it’s going to be VERY difficult to handle IV issues – especially if your only IV has problems. Ensure the IV is running and monitors are still functioning after tucking the patient’s arms

Dermatochalasis is excess skin of the lower or upper eyelids. Most patients will have a blepharoplasty because of cosmetic concerns related to the dermatochalasis. However, the excess skin may also cause visual obstruction and ectropion (when the lower eyelid droops away from the eye). A pathological concern for the upper eyelid is ptosis.

The surgery can either be an upper or lower eyelid Blepharoplasty. Some surgeons call it a “bleph”.

Upper lid Blepharoplasty: the surgeon will excise a wedge of the upper eyelid.

Lower lid Blepharoplasty: the surgeon will create an incision along the lower lash line or along the conjunctive of the lower lid. Fat will be repositioned from there. Depending on the extent of droopiness of the lower lid, the surgeon may

Depending on the laxity or droopiness of the lower lid, your surgeon may also perform an canthopexy or canthoplasty.