Local anesthesia for double eyelid ptosis surgery

When performing double eyelid and ptosis surgery, it is very important to use local anesthesia for two reasons.  One is during ptosis surgery, the patients should open one’s eyes so that the surgeon can determine how high or low the eyelid has been elevated.  The eyelid is elevating structure also known as the levator muscle has a characteristic of a muscle.  That characteristic is that muscle functions are different from one patient to another.  In addition, between the two eyelid muscles, the muscle function can differ as well.  Think about one’s right and left biceps muscle.  Do they have the same muscle strength?  They don’t.  Therefore, by having the patient open eyes, the levator muscle can be tightened accordingly and adjusted for subtle differences.  And this can only be done while the patient is awake with the use of local anesthesia.

For the during double eyelid surgery, by having the patient open eyes, we can determine how much eyelash eversion should be.  It is not as simple as fixing the eyelid skin to the levator aponeurosis (distal part of the levator muscle).  Eyelid skin has different tensile strength or stretchability.   If the eyelid eversion is not enough, then a swollen eyelid appearance will form.  And if the eyelid eversion is too great, then ectropion or eyelash will evert too much.

As one can see, in double eyelid and ptosis surgery, it is imperative that patient remains awake during the surgery to get the most natural result. The patient being groggy with iv anesthesia also leads to subpar result as they will not open their eyes under iv sedation as their normal state. They will open with their brow elevated. Thus, their postoperative result will look unnatural.

Therefore in South Korea, an overwhelming majority of plastic surgeons perform double eyelid and ptosis surgery under local anesthesia. Dr. Kenneth Kim, a board-certified plastic surgeon in Los Angeles also performs double eyelid and ptosis surgery under local anesthesia.