Anesthesia Options for Cosmetic Surgery

Rest Easy Sleeping Beauty.  Cosmetic Surgery is Truly Painless.

Plastic Surgeon Dr. Williams Talks Anesthesia Options for Cosmetic Surgery

Patients often ask what are my options for anesthesia.  The term anesthesia means a temporary loss of sensation or awareness.  So, the choice really depends on the procedure.

In the 21st century I believe there is no reason a surgical procedure should be an unpleasant experience for the patient.  Our goal here at the Williams Center is to use just the right amount of anesthesia no more no less – given the procedure and individual patient.

Local Anesthesia Numbs Pain While You’re Awake

There are basically three categories of anesthesia which can also be further subdivide as local, sedation, sedative, or general anesthesia.  Local anesthesia is basically when the doctor injects the area undergoing surgery with a local anesthetic to eliminate or block any painful sensation or stimuli.

The public generally refers to this as Novocain but the most common local is Lidocaine.

When Lidocaine is injected correctly, the patient can fell touch but will not fell painful sensation that occurs when a surgical incision is created or when tissue dissection takes place.  The local anesthetic takes a few minutes to be effective and generally lasts for a few hours depending on the specific type of anesthesia injected.

There are a few different types of local anesthetic some more shorter active and some longer.  For example, one anesthetic Marcaine is used when prolonged pain can occur from an operation like harvesting graph cartilage or in an abdominoplasty more commonly referred to as a tummy tuck.  This anesthetic lasts about 12 hours or more an did very helpful in the early postoperative period keeping a patient more comfortable than a shorter acting local anesthetic like lidocaine.  Finally, a local anesthetic may have a dilution of epinephrine, more commonly referred to as adrenaline.

The adrenaline can be added to the local anesthetic as it causes a very small blood vessels to constrict or shrink resulting in less bleeding during a surgical procedure.  Naturally that is desirable for the surgeon and the patient.  It is not unusual for a surgeon to use a local anesthetic in conjunction with general anesthesia or sedation to reduce or “cut down” on the amount of general anesthesia required for the patient.  This is desirable for obvious reasons.

Sedation – Oral and Intravenous Anesthesia

The next broad category of anesthesia is sedation.  The sedation can be oral sedation where the patient takes by mouth valium or its sister drug like Ativan.  This is helpful for relaxing the patient a little before the procedure and commonly used for shorter procedures lasting less than an hour or so and can be used with a local anesthetic.  We commonly offer this option to a patient having a weekend lift of or liposuction on outpatient basis for those who want a little more local sedation.

Sedation can also be accomplished by intravenous sedation often referred to as MAC – Monitored Anesthesia Care.

MAC is often used for procedures lasting more than an hour or so or a procedure where oral sedation is not likely to be sufficient alone to keep the patient comfortable as in Rhinoplasty or Facelift surgery.  MAC is commonly administered by a Certified Registered Nurse, a Certified Anesthesia Provider like a CRNA ( A Certified Registered Nurse Anesthetist).  During the surgical procedure, the patient’s vital signs and many other parameters are monitored very closely at the same time the anesthesia is administered by the CRNA or Anesthesiologist.

Because the patient is not aware of this type of anesthesia it is often referred to as a conscious sedation and is commonly used in our practice for blepharoplasty, breast augmentation, and other procedures.

Also, an intramuscular anesthesia is used occasionally as a sedation for some patients.  Basically, an injection or “shot” is given which provides anesthesia somewhere in between intravenous and oral sedation.  This is commonly used on a hair transplant or restoration procedure which often requires a little more oral sedation.

General Anesthesia for More Extensive Procedures

The last category of anesthesia for this discussion would be general anesthesia.  During general anesthesia, the patient is essentially asleep and will not arouse easily.  Most general anesthetics are inhalation agents adjusted through an endotracheal tube or LMA (laryngeal mask anesthesia) both commonly referred to as a breathing tube.  The anesthesia provider will titrate the anesthesia to the individual and sometimes use more than on anesthetic agent in the “cocktail” to avoid or prevent some of the side effects like postoperative nausea and vomiting.  Additionally, like sedation anesthesia, general anesthesia is administered with local anesthesia to “cut down” or reduce the amount of anesthesia provided.

Safer than Ever

For many years, MAC sedation was considered a little safer than general anesthesia, however, in the past couple of decades the data strongly supports an equal level of safety between sedation anesthesia (MAC) and general anesthesia.  It often becomes a matter of preference to the surgeon.  General anesthesia is frequently used in our practice for patients under going full Facelift or Abdominal Surgical Procedures as well as many others.

Please call the Williams Center at 518-786-7000 for any further questions or concerns you may have.