Is Anesthesia Safe for Plastic Surgery? FAQs & Expert Insights

For a healthy person – which describes everyone who has aesthetic surgery at our facility – the odds of anesthesia causing long-lasting damage are extremely low. Older individuals, or those with pre-existing medical conditions, are at higher risk.

There is a chain of liposuction clinics that used to promote the idea that general anesthesia is more dangerous than local anesthesia (maybe they still do), but that is not necessarily the case. It is possible to do lipo with local anesthesia using a method called the tumescent technique, but this involves using high doses of the numbing agent lidocaine when larger volumes of fat are removed. We often use tumescent for smaller cases, and it is safe if done right. But there have been serious complications from using tumescent for larger-volume lipo, so it is categorically not safer than general anesthesia. The red flag here is when the facility pushes you toward a procedure using only the tumescent technique because they are not licensed to do general anesthesia. At Phase Plastic Surgery, we offer all anesthesia options so that we can provide whichever method is the safest and most comfortable for each patient.

Great progress has been made in understanding the causes of post-operative nausea (often combined with vomiting and termed PONV). There are several options to prevent PONV and to treat it when it does occur. If you have experienced PONV, you know it is almost worse than pain. The good news is that if we are aware that you have had this experience, there is a lot we can do to prevent it. The first is a medication called aprepitant (brand name Emend), which is extremely effective but has to be taken before anesthesia. It is a little bit expensive, usually costing upwards of $80 for one prescription, but well worth it. Some pharmacies do not carry it in the appropriate dose, so, because we want to make sure our patients have access to it, we can provide it directly.

There are several other strategies we have to minimize PONV. These include the ERAS protocol, which is designed to optimize pain management with less reliance on opioids, which can contribute to the problem. Also, your anesthesia provider can make adjustments to the anesthetic itself if you are known to have an issue with previous anesthetics. Finally, but equally important, is the prevention of post-op pain. One of the keys to this is the use of long-acting numbing agents, such as Exparel. This is placed into the surgical site during the procedure and/or as an ultrasound-guided nerve block (called a TAP block), which we have found reduces pain scores and opioid use by 50 percent. We have been doing this for many years now, and I am amazed that this is still not offered everywhere.