Q: Can eyelid surgery be done without anesthesia?

Can bleph eyelid surgery be done without anesthesia? If so, how does it work?

A: It depends on what you call "anesthesia."
As you can see from all of the responses, most surgeons have recommended "local anesthesia," which is a form of anesthesia, simply not the type in which you go to sleep. I recommend local anesthesia, which requires placing anesthetic with a small needle in and around the area for surgery. Placing the anesthetic can be uncomfortable, but generally well tolerated. The advantage is that you can participate in opening and closing your eyelids. This can be a critical part of the operation.

--Asked on Realself.com

Q: Possible levator muscle injury from eyelid surgery?

A: Levator muscle and repair in upper lid blepharoplasty
You are now 2 weeks out from the surgery and by this time, you eyelids should have accomodated to each other. If you still have signficant ptosis at this point, it is likely that the levator muscle or attachment to the tarsus is not functioning fully and will likely not resolve with further waiting. In other words, the transient effects of medication, brusing, swelling, etc, should have mainly dissipated.

There are a number of possibilities that are causing your eyelid asymmetry at this time, but removing too much fat is likely not one of them. My advice is for your to wait and be patient a while longer (minimum of 3-4 weeks). If you require further treatment, the levator may be explored, tightened, or "advanced." By this time, you will also see that the scars on the lateral incision will have healed much further.

(From RealSelf.com)

Asian Double Eyelid Surgery

This is an extremely technical operation that requires significant precision and skill. I liken this operation to microsurgery as the sutures and precision required to create symmetry and the functional crease with the levator aponeurosis to be of equal value. I perform this operation under high magnification and place sutures as precisely as I do with blood vessels that are less than 1 mm in diameter.

The double eyelid operation is one of the most popular procedures performed in Asia. It must be performed keeping in mind the natural aesthetics of the Asian eye, not merely to Westernize the eye.

I spend a lot of time with the patient setting the height of the new lid crease. This is a highly personal choice by the patient, which must be followed precisely during the operation. It is important to remember that the lid height can always be shortened, but at a later date cannot be lengthened. This means that I pay great attention to the patient's aesthetics about lid height and whether more or less lower lid show is desired. Some patients desire a very natural, smaller crease, whereas some patients desire a much higher, glamorous lid height to place more makeup. These lid heights can vary between 5 mm to 9 mm.

What is Asian Cosmetic Surgery?

Asian Cosmetic Surgery is plastic surgery that understands the anatomical differences of Asians and the different standards of "Beauty" that come from this understanding. This is a subtle, but very fundamental difference that can make an outcome good versus bad. Even though the exact same operation may have been performed between two individals, (Example: Asian versus Causasian) the expectation and the judgement of outcome can be entirely different. At its core, plastic surgery is the same, but in its different forms, there can be real and subtle differences.

For example, the eyelid operation (blepharoplasty) that is commonly performed on many Asians to create a more "Western" appearance (creation of a supratarsal crease) must keep in mind the different anatomy and expectation of the lid and crease position. Too often, I have seen the position of the lid and crease in a position that does not bring out the "beauty" of the eye. Instead, it is more a stylized attempt at trying to create a Caucasian eyelid on an Asian. Asian eyelids have specific charateristics, unique anatomy, and natural lines that should not be dramatically altered.

Performing Asian Cosmetic Surgery requires specific training and understanding of these ideals. I have personally spent time as a Visiting Professor at Seoul, Korea's top Hospitals and Plastic Surgery practices, where Asian Cosmetic Surgery is considered the best in the world. I have learned from these superb surgeons and also lectured to their residents on topics in Plastic Surgery. These experiences, combined with practicing in a multicultural city like San Francisco, have allowed me to hone my skills to treat Asian who desire cosmetic surgery.