Many cosmetic patients want to avoid the risks of general anesthesia as well as side effects such as memory loss, confusion and nausea. Mothers concerned about their children, want to minimize the risk of undergoing a cosmetic surgery.
Why undergo any cosmetic procedure under local anesthesia?
1) Local anesthesia has less risks than general anesthesia.
2) There is less post operative pain.
3) There is no post anesthesia nausea.
4) Better post op pain control leads to quicker recovery.
Demand for “Awake” cosmetic surgeries are a growing trend despite resistance from the “old school” of surgeons who are reticent to embrace the advantages local anesthesia.
A recent two state study on outpatient cosmetic surgeries reported by Medscape (http://www.medscape.com/viewarticle/758346) demonstrated adverse events requiring hospitalization was related to multiple cosmetic procedures performed under general anesthesia. There was no correlation to type of surgeon, board certification or facility accreditation.
Upon awakening from general anesthesia patients feel pain immediately. With local anesthesia the patient is relatively comfortable in the immediate postoperative period. After surgery, oral pain medications is given before the local anesthesia wears off, minimizing the development of severe post op pain. Because none of our patients receive narcotic medications during their procedure there is no anesthesia related nausea. However some patients may develop nausea with pain medications.
In my first medical career as a general, vascular and transplant surgeon I frequently dealt with emergency surgeries. General anesthesia was a necessity. However, we noticed over the decades that many elective outpatient procedures were performed under local anesthesia with less complications, less hospitalizations and quicker recovery.
The surgeon who best serves outpatient “awake” cosmetic patients are skilled in the administration of local anesthesia. The cosmetic surgeon must embrace the principle that gentle surgical technique outweighs the benefit of operating “faster” on an asleep patient under general anesthesia.
I recently read a colleague claim that they know of patients who have wakened during their local anesthesia cosmetic surgery with severe pain. I believe this is a misrepresentation. If the patient “woke up”, then they were not truly undergoing an “awake” procedure. They must have been heavily sedated and they received an inadequate amount of local anesthesia.
As diplomat of the American Board of Cosmetic Surgery, and a board certified general surgeon I believe that local anesthesia offers less risk than general anesthesia or deep sedation. I am proud to offer my cosmetic patients the alternative of awake laser liposuction, awake tummy tucks, awake breast augmentation and lift, awake facial fat grafting, and awake laser varicose vein surgery. To date none of my patients have required hospitalization.
Awake procedures can be performed comfortably in the appropriate patient with a patient and skilled surgeon. The safety and overall patient satisfaction have been noteworthy.
In Beauty and Health,
Dr. Tom
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