Understanding Anesthesia in Plastic Surgery
In the realm of plastic surgery, particularly those procedures involving incisions, anesthesia is an indispensable component. While many individuals may be eager to undergo a procedure they have long desired, the prospect of pain can be a significant deterrent. Discomfort can not only affect the procedure itself but also the recovery period.
General anesthesia, which induces a state of complete unconsciousness, is often preferred for these reasons. It also helps alleviate anxiety and distress caused by sensory experiences during the surgery. However, as Dr. Bruce Moskowitz, a board-certified oculoplastic surgeon in New York City, points out, general anesthesia comes with its own set of costs and side effects. In some cases, it may not be necessary to ensure patient comfort. Twilight sedation, a step below general anesthesia, allows patients to remain conscious and breathe independently. Yet, many procedures can be effectively managed with local anesthesia, which can be more advantageous depending on the specific surgery. Here are six common procedures typically conducted under local anesthesia.
Liposuction
Liposuction is particularly suitable for local anesthesia in specific body areas. Ideal locations include small, superficial, and isolated regions such as the arms, double chin, and fat pockets around the thighs. The stomach is less suitable for this approach. Superficial fat in these smaller areas is generally easier to remove. Dr. Michael Bassiri-Tehrani, a board-certified facial plastic surgeon in New York City, explains, "The targeted fat is situated beneath the skin and can be removed without aggressive suction, thereby reducing the likelihood of significant bleeding."
The outcome of the procedure remains unaffected, as it is conducted in the same manner as when the patient is under general anesthesia. However, some sensations might be perceptible. Dr. Andrew T. Cohen, a board-certified plastic surgeon in Los Angeles, notes, "There is some mild tenderness as we introduce the tumescent fluid prior to liposuction, but after that, it becomes entirely numb." Despite the numbness, patients might still feel pressure, though it is typically not uncomfortable. Additionally, the sound of the suction might be noticeable, which could be a concern for some patients.
Lip Lift
A lip lift involves removing a small band of skin beneath the nose and elevating the upper lip with supportive sutures to enhance its appearance. This procedure is better suited for local anesthesia. Dr. Bassiri-Tehrani explains, "Having both the upper and lower lips visible without an anesthesia breathing tube obstructing the view can assist in visualizing the appropriate proportions."
Numbing the upper lip is straightforward, and patients can feel so at ease that they may attempt to speak during the procedure. Dr. Bassiri-Tehrani adds, "Normally, we will guide patients during the surgery as to when it's safe to talk and when we require them to remain still." Although bleeding might occur and be visible, it can be easily controlled.
Related: The Ultimate Guide to Fuller Lips – From Plumping Glosses to Silicone Implants
Facelift
Procedures involving the skin, such as facelifts, fat grafting, certain brow lift techniques, and earlobe repair, are generally suitable for local anesthesia. Dr. Moskowitz states, "Despite the sensitivity of the skin, local anesthesia combined with regional nerve blocks is highly effective in providing a pain-free experience." The only discomfort encountered is from the initial injections to numb the areas.
Both mini lifts and full facelifts can be performed under local anesthesia. Dr. Cohen explains, "The tissues are numbed using local anesthesia and some sodium bicarbonate to minimize the pain. The skin is repositioned exactly the same as under general anesthesia." He often includes an oral sedative to help patients relax before the surgery.
Upper Eyelid Blepharoplasty
An upper eyelid blepharoplasty, which involves removing excess skin and sewing the incision back together, is a preferred option under local anesthesia, provided the patient is comfortable being awake during the procedure. Dr. Bassiri-Tehrani explains, "Excessive or loose skin of the upper eyelid can be carefully removed under local anesthesia due to the limited area of the procedure." Excess fat can also be removed through the same incision, with careful application of local anesthesia preventing any sensation.
While it is technically possible to perform both upper and lower eyelid blepharoplasty, focusing on the upper eyelids is advisable. The lower eyelid has more fat, which is easier to reposition under sedation. Patients need to be comfortable sitting still and keeping their eyes closed throughout the procedure. Dr. Bassiri-Tehrani notes, "Just like all awake surgeries, patients need to be evaluated for their comfort level of being conscious during the surgery."
Buccal Fat Excision
Buccal fat removal is typically done through a small incision in the mouth. The risk of bleeding is minimal, and patients are accustomed to numbing injections from dental treatments, making the procedure feel normal. Dr. Bassiri-Tehrani explains, "The pressure can sometimes be uncomfortable, so some oral medication to keep patients relaxed can be administered." Occasional interruptions for spitting or suctioning occur, but these do not affect the procedure. In fact, patient responsiveness can help keep the airway open and clear.
Related: Buccal Fat Removal – and the Debate Surrounding the Insta-Famous Fix
Otoplasty (Ear Pinning)
Otoplasty, also known as ear pinning, adjusts the size and shape of the ears and is often used to correct prominent ears. The nature of the ears allows for effective local anesthesia. Dr. Bassiri-Tehrani states, "The nerve endings for pain going to the ear can be effectively blocked with small injections around the ear, allowing for a very effective nerve block without distorting the ear."
Patients will not experience sharp pain during the procedure but will feel the pulling and pressure on their ears. They will also be able to hear everything happening, which might be unsettling, especially for child patients.
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