Types of anesthesia used in Cosmetic surgery

” I want my Tummy Tuck performed with the least amount of anesthesia complications.”

Some of you may have read my posts on why I like to do Breast augmentation under IV sedation. I also do IV sedation with propofol for all major and combined procedures. Naturally, some patients are anxious because they don’t want to feel anything, but they are attracted to the idea of not undergoing general anesthesia. There is also some confusion as to what exactly is IV sedation.

This is understandable because there are many levels of sedation. I will explain the different levels so you can make a more informed decision when discussing this with your surgeon or anesthesiologist.

we often refer to the three distinct choices: local, IV sedation with propofol or General anesthesia.

In cosmetic surgery, we often refer to the three distinct choices: local, IV or General anesthesia. However, I have outlined all of the slight variations to five levels so you can fully understand the entire spectrum of anesthesia. 

In general, my bias is to use as minimal sedation as possible, but ensure that the patient does not feel or remember anything. Following are examples of increasing levels of anesthesia and examples of cases that might be suitable.

Five levels of Anesthesia for cosmetic surgery procedures

The levels of anesthesia used in Cosmetic Surgery are:

• local anesthesia only
• local anesthesia with valium
• IV sedation moderate, also known as Twilight Anesthesia
• IV sedation with propofol- deep sedation
• General Anesthesia with a ventilator

Below is a summary of what each of these levels involve.

Local anesthesia only

This is suitable for small lumps and bumps. I have used it for small wound revisions, but you have to know very well what your level of pain tolerance or anxiety is. If you are anxious about needle sticks, you might consider going up to the next level.

Local anesthesia with valium

This usually means giving the patient some Valium or other anxiolytic agent in combination with pain medication such as Percocet by mouth. This is done a good half hour before surgery. The patient should be visibly relaxed or sleepy. In combination with a good local anesthetic, we can do Eye lifts, liposuction of small areas, lip lifts, fat injections to the face, and scar revisions.

IV sedation Moderate, also known as Twilight anesthesia

This level of anesthesia includes amnesic drugs, which make the patient forget what happened during surgery. The patient is usually asleep, but able to breathe on his/her own. This type of anesthesia should be administered with a CRNA or Board Certified Anesthesiologist.

If the patient feels some pain they may verbalize, or even move some. We generally will then administer more local anesthesia which will be adequate for the level of surgery we are doing.

Sometimes patients may need small adjustments in head position to help them breathe better. Upon emerging from sedation patients do not remember what went on and sometimes will even ask if surgery was done. This type of sedation is great for  Facelifts, Fat transfer, and mini tummy tucks.

IV Sedation with Propofol- Deep sedation

This is the type of sedation that I use for most of my major procedures. This type of sedation is done with a Board Certified Anesthesiologists . With deep sedation the patients are able to breathe on their own but may need an assistive device such as a nasal airway or oral airway. We can do any kind of major plastic surgery with this anesthesia including Tummy Tucks, Breast Augmenations, Mommy Makeovers, Body lifts, and combined procedures.

The simultaneous use of tumescent local injections into the operative area plays an important role in being able to use IV sedation. Tumescent fluid is a local anesthetic which numbs the area and restricts blood loss. The tumescent solution blocks a lot of pain signals during the surgery which allows us to use this lesser form of IV with propofol anesthesia.

Another benefit of the tumescent local injections is that the pain relief is long lasting, and extends past the end of the surgery. Therefore, the usage of tumescent solution is critical to being able to use IV sedation with propofol for major cosmetic surgeries. It is  rare that a patient will ever feel or remember any pain with this type of anesthesia.

General sedation, or General Anesthesia

These patients need respiratory support and are on a ventilator. Patients have tubes down their throat and their nose. This process is called intubation with a ventilator. We at Cosmeticsurg do not believe it is necessary to use TIVA, as we can achieve all our goals with lesser amounts of anesthesia.

Many plastic surgeons use this type of anesthesia, as it typically makes the surgery go a fit faster. However, the downside of this type of anesthesia is that it introduces a higher risk of DVT, pulmonary embolisms, and patients often times have more nausea.

The problems of nausea and prolonged recovery are eliminated with IV sedation. More importantly, there is no increased risk with increased time of surgery.

Best Anesthesia choice for major cosmetic procedures is IV sedation with propofol

I feel very strongly that monitored IV sedation with propofol is the way to go ! I believe this type of anesthesia is safer for the patient, and the patient recovers quicker with very little nausea

VIDEOS

• See me speak with two different patients, one 20 minutes after a 2-hour procedure and the other 40 minutes after a 9-hour procedure: Twilight IV anesthesia interview video.
• See Dr. Hobelmann, a Board Certified Anesthesiologist, talk about the difference between twilight IV anesthesia vs. general anesthesia: IV anesthesia vs. General anesthesia.

(originally published May 18, 2009)