When considering a medical procedure, one of the first questions you may ask your doctor is whether the procedure calls for general or local anesthesia. You have probably heard about the added risks of general anesthesia—or “going under”—in the media and may even know someone who has had adverse effects. As a result, you would likely rather avoid general anesthesia, so when thinking about elective surgery, the type of anesthesia the procedure calls for often influences your decisions to, well, elect the surgery.
I find that many prospective patients are surprised when I tell them I rarely usegeneral anesthesia when performing facial plastic surgery. In fact, I only use it if necessary–if the patient has some other medical condition that requires general anesthesia or if he or she prefers general, as I do not have a one-size-fits-all approach.
With local or twilight anesthesia, I perform the same procedures with less risk to the patient, while offering faster recovery time. In my practice, 30 percent of procedures are performed under local anesthesia and 70 percent under twilight anesthesia.
Under local anesthesia, facelifts, rhinoplasties or “nose jobs,” eyelid lifts, lip, chin and cheek augmentation, and many other procedures can easily and safely be performed while the patient is wide awake. A minor sedative like Valium in a pill form is administered, followed by Novocaine-like local shots (similar to what one would receive at the dentist) injected to numb the part of the face having surgery. We use drugs called Lidocaine and Marcaine because they last longer and are more effective than Novocaine. The shots can be painful, and multiple shots are needed, but tiny needles are used to minimize discomfort. Because of some discomfort, I do not suggest this procedure for those who are afraid of needles or have a very low pain threshold.
One of the many upsides of local anesthesia is that it decreases the amount of bleeding during surgery when compared to general anesthesia, therefore bruising and swelling is lessened. There are also cost savings because an anesthesiologist is not needed.
For patients who prefer not to be awake and aware during surgery, we perform a twilight anesthesia. This is the same anesthesia given intravenously during a colonoscopy, called Propofol. This medication is like an intravenous Valium, but as soon as the medicine is “turned off,” you wake up without any nausea, headache, or “hangover” from general anesthesia gas. Twilight anesthesia also reduces bruising compared to general anesthesia. It is extremely safe, and patients often feel great after surgery, as if they have just had a deep sleep. Anyone who has had a colonoscopy has experienced twilight anesthesia.
Now that we know a bit about local and twilight anesthesia, what exactly is general anesthesia, and how does it impact the body? General anesthesia involves an anesthesiologist administering drugs that lead to temporary paralysis during surgery, including placement of a breathing tube. This causes physiologic changes to the body, including dilation of blood vessels, which increases bleeding during surgery and in turn increases post-operative bruising and swelling. General anesthesia can also produce post-operative nausea and vomiting, which can lead to further trauma and torn sutures in some patients.
Many plastic surgeons will only perform surgery under general anesthesia. While I agree that the risks of having serious complications after general anesthesia are extremely low (less than .001 percent), there is no question that the rate of nausea, discomfort, and the increased bruising and swelling associated warrant these surgeons to reconsider their approach.
When talking to your doctor about any surgical procedure, it is important to do your homework. For an aesthetic facial procedure, you should select a board-certified facial plastic surgeon with impressive before-and-after results. Meet with the doctor prior to the procedure to make sure he or she understands your anti-aging goals and answers all questions to your satisfaction. Remember, always go with your gut–if something doesn’t feel quite right to you, get a second opinion.
By Dr. Andrew Jacono