Anesthesia and Cosmetic Surgery
One of the biggest humanitarian innovations in the history of civilization was the discovery of anesthesia. Prior to the discovery of ether anesthesia in the 1840’s, people were pretty much tortured during surgical procedures and “bitting the bullet” had a very literal meaning. The best Civil War battlefield surgeons were those who could most rapidly remove a limb. Fast surgery was very important at one time. The first part of the 20th Century ushered in the discovery of local anesthetics with Novacaine being the first agent. This was another huge advance as it made anesthesia “portable” safer and provided patients with another surgical anesthetic option. Prior to this, having a mole removed or a tooth worked on was a tough deal!
We are lucky to live in an era of multiple anesthetic options for cosmetic surgery. General anesthesia is the deepest form of surgical anesthesia. This technique is defined by an unresponsive patient that cannot follow commands and requires assistance with life support. Although the lighter anesthetic procedures allow the patient to breath on their own, the deeper techniques “breath for the patient” by using a ventilator on the anesthesia machine. A breathing tube is frequently placed through the mouth or nose and through the vocal cords to enable the oxygen and anesthetic gases to enter and the carbon dioxide to be exhaled. Although some cosmetic procedures are better performed with general anesthesia, there has been a giant trend to not use such deep anesthetic techniques. Many surgeons feel that general anesthesia adds additional risks with cosmetic surgery.
The second type and most common anesthetic technique is IV sedation or M.A.C. (monitored anesthetic care) anesthesia. With IV sedation the patient does not need a breathing tube and breaths on their own the entire case. IV sedation can be light, where the patient is relaxed and can respond to commands, or deeper where the patient is totally unconscious. MAC anesthesia is a very safe technique and is “fast on and fast off” meaning that the patient quickly is sedated then quickly wakes up when the drugs are stopped. Many patients have had experience with this type of anesthesia from wisdom tooth surgery or colonscopy. Newer drugs decrease the post anesthesia sickness, nausea and vomiting seen in the past. For general anesthesia and IV sedation the patient must refrain from food or water for about hours before surgery.
Oral sedation is another option and involves taking a sedative pill before the procedure. Although this relaxes the patient, it does little for pain control so local anesthesia must be used as well.
Tumescent anesthesia involves mixing saline with the local anesthetic Lidocaine and very small amounts of epinephrine. This is most frequently used for liposuction and facial surgery procedures. This mixture enables pain control and reduces bleeding. Tumescent anesthesia has revolutionized cosmetic surgery anesthesia as many procedures may be done with this type of anesthesia, totally awake.
Local anesthesia is another popular form of awake anesthesia and is the same mechanism as going to the dentist. Eyelid surgery and other cosmetic procedures are sometimes performed with only local anesthesia. Local anesthesia or tumescent anesthesia is also frequently used with general anesthesia and IV sedation to enhance pain control. This also reduces the amount of anesthetic agents necessary to keep the patient asleep as well as keeps the patient numb for a while after they awake.
Most anesthetic techniques are very safe and statistically patients have a higher chance of being in a motor vehicle accident than having a serious anesthetic problem or death. Obviously there are risks of undergoing any type of anesthesia and all cosmetic surgery and anesthesia patients must be thoroughly evaluated by a doctor prior to having anesthesia. Smoking, obesity, diseases and allergies can all put patients at increased risk for anesthesia. Fortunately, most patients desiring cosmetic surgery are usually healthy enough to undergo some type of anesthesia. For those whom aren’t, staying alive is a better option than looking better.
If you are considering cosmetic surgery discussion your anesthesia with your surgeon is an important part of the informed consent process and should be given serious consideration by all patients. It is important to know what type of anesthesia you will be getting and who will be administering it. Some surgeons are trained and experienced in ambulatory outpatient office anesthesia and along with their staff provide the anesthesia and surgery. It is important that in this situation, the doctor’s office has the same level of monitoring, emergency drugs and devices as a hospital. For more complex anesthetic or medically compromised patients, nurse anesthetists or physician anesthesiologists usually provide anesthetic care.
To find out more about cosmetic facial surgery by Dr. Joe Niamtu in Richmond, Virginia visit www.lovethatface.com.
Joe Niamtu, III DMD
Cosmetic Facial Surgery