Local anaesthetic-only upper blepharoplasty: a viable alternative?

Main Article Content

Robert Phan
Frank Lin

Keywords

blepharoplasty, anaesthesia, surgical wound infection, eyelids, Australia

Abstract

Introduction: Local anaesthetic-only upper blepharoplasties are not routinely performed in the clinic in Australia. There is a lack of data to demonstrate whether they are any less safe or efficacious compared with upper blepharoplasties performed with sedation or general anaesthesia (GA) in theatre. Perioperative and postoperative antibiotics may also be administered for surgical site infection (SSI) prophylaxis. This paper aims to determine whether local-only upper blepharoplasties are safe and efficacious compared with upper blepharoplasties performed with sedation or GA, and whether prophylactic antibiotic use is indicated.


Method: A retrospective analysis of patients undergoing upper blepharoplasties from a single surgeon’s private clinic was performed from March 2014 to October 2018. The clinic’s database was interrogated and patient age, anaesthetic type, operative site, use of peri- or postoperative antibiotics, and complications were recorded including infection, return to theatre, chemosis and asymmetry noted by the patient and requiring revision surgery.


Results: A total of 97 patients were included for analysis. Complication rates of local-only upper blepharoplasties performed in the clinic were not higher than when performed under sedation or GA in theatre. When analysing antibiotic use, although 32 of the 97 patients (33%) were not prescribed antibiotics preoperatively, postoperatively, or pre- and postoperatively, no patients developed infections.


Conclusion: When performed by a qualified surgeon with appropriate equipment, local-only upper blepharoplasties carried-out in the clinic are as safe and efficacious as those performed with sedation or GA in theatre. Prophylactic antibiotic use demonstrated no advantage in SSI prevention for patients undergoing upper blepharoplasties.

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References

1. Neimkin MG, Holds JB, Hepburn A. Evaluation of eyelid function and aesthetics. Facial Plast Surg Clin North Am. 2018;24(2):97–106. http://dx.doi.org/10.1016/j.fsc.2015.12.002 https://doi.org/10.1016/j.fsc.2015.12.002 PMid:27105795
2. Kruavit A. Asian blepharoplasty: an 18-year experience in 6215 patients. Aesthetic Surg J. 2009;29(4):272–83. http://dx.doi.org/10.1016/j.asj.2009.04.004 https://doi.org/10.1016/j.asj.2009.04.004 PMid:19717058
3. American Society of Plastics Surgeons. 2017 plastic surgery statistics report [PDF on internet]. Arlington Heights, ILL: American Society of Plastics Surgeons [2018; cited 2 December 2018]. Available from: https://www.plasticsurgery.org/documents/News/Statistics/2017/plastic-surgery-statistics-full-report-2017.pdf
4. Kaltreider SA. Upper lid blepharoplasty and blepharoptosis repair. Oper Tech Otolaryngol. 1999;10(3):169–76. https://www.optecoto.com/article/S1043-1810(99)80053-0/pdf
5. Nekhendzy V, Ramaiah VK. Prevention of perioperative and anesthesia-related complications in facial cosmetic surgery. Facial Plast Surg Clin North Am. 2018;21(4):559–77. https://doi.org/10.1016/j.fsc.2013.07.011 PMid:24200375
6. Trapasso M, Veneroso A. Local anesthesia for surgical procedures of the upper eyelid using filling cannula: our technique. Plast Reconstr Surg. 2014;2(5):1–2. https://doi.org/10.1097/GOX.0000000000000071 PMid:25289336 PMCid:PMC4174072
7. American Society of Plastics Surgeons, American Society of Plastic Surgeons. Plastic Surgery Statistics Report, 2016.; 2016. https://d2wirczt3b6wjm.cloudfront.net/News/Statistics/2015/plastic-surgery-statistics-full-report-2015.pdf. Accessed December 2, 2018.
8. Davison PG, Cobb T, Lalonde DH. The patient’s perspective on carpal tunnel surgery related to the type of anesthesia: a prospective cohort study. Hand. 2013;8(1):47–53. https://doi.org/10.1007/s11552-012-9474-5 PMid:24426892 PMCid:PMC3574473
9. Patrocinio TG, Loredo BAS, Arnez Arevalo CE, Patrocinio LG, Patrocinio JA. Complications in blepharoplasty: how to avoid and manage them. Braz J Otorhinolaryngol. 2011;77(3):322–27. https://doi.org/10.1590/S1808-86942011000300009 PMid:21739006
10. Whipple KM, Korn BS, Kikkawa DO. Recognizing and managing complications in blepharoplasty. Facial Plast Surg Clin North Am. 2013;21(4):625–37. https://doi.org/10.1016/j.fsc.2013.08.002 PMid:24200381
11. Schwarcz RM, Kotlus B. Complications of lower blepharoplasty and midface lifting. Clin Plast Surg. 2015;42:63–¬71. https://doi.org/10.1016/j.cps.2014.08.008 PMid:25440742
12. Sniegowski M, Davies B, Hink E. Complications following blepharoplasty. Expert Rev Ophthalmol. 2014;9(4):341–49. https://doi.org/10.1586/17469899.2014.928201
13. Vamvakidis K, Rellos K, Tsourma M, Christoforides C, Anastasiou E, Zorbas KA, Arambatzi A, Falagas ME. Antibiotic prophylaxis for clean neck surgery. Ann R Coll Surg Engl. 2017;99(5):410–12. https://doi.org/10.1308/rcsann.2017.0041 PMid:28462662 PMCid:PMC5449706
14. Gagliardi AR, Fenech D, Eskicioglu C, Nathens AB, McLeod R. Factors influencing antibiotic prophylaxis for surgical site infection prevention in general surgery: a review of the literature. Can J Surg. 2009;52(6):481–89. http://www.ncbi.nlm.nih.gov/pubmed/20011184
15. Bykowski MR, Sivak WN, Cray J, Buterbaugh G, Imbriglia JE, Lee WPA. Assessing the impact of antibiotic prophylaxis in outpatient elective hand surgery: a single-center, retrospective review of 8850 cases. J Hand Surg Am. 2011;36(11):1741–47. https://doi.org/10.1016/j.jhsa.2011.08.005 PMid:21975095
16. de Keizer ROB, Kozdras G, Wubbels R, van den Bosch WA, Paridaens D. Retrospective study in 608 cases on the rate of surgical site infections after orbital surgery without prophylactic systemic antibiotics. Br J Ophthalmol. 2018. https://doi.org/10.1136/bjophthalmol-2018-312232 PMid:30578245