Regional Nerve Block Anesthesia in Upper Blepharoplasty

Abstract

Background: Local anesthesia is commonly used in upper blepharoplasty but presents several drawbacks, including swelling and distortion of the upper eyelids. These effects can lead to temporary intra- and postoperative pseudoptosis, complicating intraoperative assessment and revision for surgeons. Additionally, local anesthesia prolongs postoperative recovery time and produces more significant anesthetic injection pain over upper eyelid incision line. However, regional nerve block anesthesia has the potential to avoid these complications occurred because it does not require injection into the upper eyelid incision itself, eliminating the possibility of pseudoptosis and reducing anesthetic injection pain. Combining this approach with a specific designed upper eyelid skin incision technique can help reduce bleeding in the incision area. In this study, we describe in detail our new method for regional nerve block anesthesia in upper blepharoplasty.

Materials and methods: We performed a retrospective review of patients who underwent upper blepharoplasty under regional nerve block anesthesia from 2009 to 2024 at the second author's clinic. Patients who underwent for aesthetic reasons or eyelid ptosis were included. Those who had undergone revision blepharoplasty for upper eyelid trauma or prominent scars on the upper eyelid were excluded. This retrospective study was based on data obtained from patients' perioperative photographs and medical records, including injection sites, volume of anesthetic solution used, injection pain response, and the intra- and postoperative effects of regional nerve block anesthesia.

Results: The study included 6,099 patients, with a mean age of 35. Each upper eyelid received an average injection of only 0.9 ml (range = 0.6-1.2 ml) anesthetic solution. In all patients, the regional nerve block anesthesia was successful during the entire upper blepharoplasty, including that of orbital fat debulking or eyelid ptosis repair. There were no cases of intra- or postoperative pseudoptosis occurred. All patients were satisfied with the results, and recovery time was shorter than traditional local anesthesia. No complications have been noted to date.

Conclusion: Regional nerve block anesthesia is a more effective alternative to traditional local anesthesia in upper blepharoplasty. It reduces swelling and distortion of the upper eyelids, as well as bleeding from upper eyelid incision line when combined with a specific designed upper eyelid incision technique. It also minimizes the volume and pain of anesthetic injections and shortens postoperative recovery time. Moreover, it prevents the occurrence of intra- and postoperative pseudoptosis, significantly improving the surgeon's ability to accurately assess surgical outcomes both during and immediate after the surgery. The anesthesia is successful, with complete or nearly total 100% effectiveness, and free of complications.

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Keywords: Blepharoplasty; Local anesthesia; Pseudoptosis; Regional nerve block; Upper eyelid anesthesia.