We are often asked whether a procedure can be done under local anesthesia where the patient is awake but the surgical site numbed. There are three good reasons to consider local for your plastic surgery operation: You skip the expense of an anesthesia provider, you don’t have the recovery time from sedation or general anesthesia, and you can resume usual activities with a clear head. It isn’t always the best choice though, and it depends on three things: The
patient, the specific procedure, and the surgeon. For minor procedures, local is almost always the way to go, but the patient has to be able to tolerate a bit of discomfort from the injection of the anesthetic. If you are “needle-phobic,” there’s no reason to put yourself through an anxious experience; often at least some oral medication to relax can be helpful.
When local is a good option – and when it’s not
Local anesthesia is not a good option for every procedure, but misinformation about it abounds. Liposuction is a classic example; small areas are routinely done under local using tumescent technique, but doing larger volumes this way can be quite uncomfortable. This may be fueled by marketing efforts from clinics that do not offer other types of anesthesia. Remember the “Lifestyle Lift?” The key to this scheme was the appeal of having your entire facelift done under local. The company is now defunct, due partly to spurious marketing practices, and possibly also the number of patients dissatisfied with the ordeal and their outcomes. We do most of our facelifts under intravenous sedation, and general anesthesia when indicated. A tummy tuck under local? Not a good idea as far as I’m concerned.
Your plastic surgeon should offer all anesthesia options
The third variable is the plastic surgeon, who should be able to offer a variety of anesthesia techniques and to listen to the patient’s concerns. We do most of our upper eyelid procedures under local, and frequently brow lifts as well. But regardless of the planned operation, we don’t hesitate to recommend IV sedation or general anesthesia when we feel that it is in the patient’s best interests.
The third set of considerations includes safety, comfort, and convenience. Local anesthesia is not automatically safer than general anesthesia in every case, and vice-versa. Comfort is important too; if we can’t ensure that the patient will be at ease with “wide awake” straight local, we aren’t going to do it. Convenience is an important factor, but not the overriding one. As the surgeon, my priorities are safety and making sure that I am able to do what needs to be done for optimal results.
