Local anaesthetic-only upper blepharoplasty: a viable alternative?

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.