If cosmetic upper lid surgery (upper blepharoplasty) is performed alone, many patients desire surgery under local anesthesia only.  That means only numbing the lid with small injections.  This may scare some, but in reality is a great way to go as no drugs are given systemically (to the whole body) by IV injection.  This makes immediate recovery much easier.  The procedure can be very comfortable if performed by a surgeon experienced with eyelid surgery (oculoplastic surgeon).

What I do is apply a numbing cream to the eyelids for 20 minutes before proceeding with surgery.  In the operating room I then apply ice to the area of injection before actually injecting.  With this preparation, when I place the needle through the skin, rarely is anything ever felt.  This technique typically makes injection of local anesthetic pain free.

I start by injecting anesthetic to the outer part of the lid.  This elevates the skin off the lid (from the underlying muscle) and makes the injected skin look white (it blanches).  You can see this in the photo below on the left.  I then use a gauze to massage the anesthetic solution towards the inner part of the lid.  This is called hydrodissection and allows  the anesthetic solution to progress to the area desired without re-injecting.  This is demonstrated on the photo below on the right.  I call this the “anesthetic crawl.”   It is a great technique of numbing without pain.

Now the lid is numbed and ready for surgery which will be pain free!!!!