Anesthesia for Cosmetic Surgery: Local vs. General

Andrew T. Cohen, MD

Article by
Beverly Hills Plastic Surgeon

General anesthesia worries many patients.  Many patients come to see me in the office and want only local and NOT general anesthesia when i know that if they are asleep they will have a better result.   Many doctors do liposuction "awake" under "local" with no anesthesia. 
Lots of smaller operations can effectively be done with just local anesthesia.  That is when you are fully awake and i inject local anesthesia into the area being operating on.  This is how i do moles, skin tags, laceration repairs on children, smaller lacerations on the hand, face or body.  Fast acting local is used called lidocaine with epinephrine.   This will last for around 2-4 hours in the area.
Local with sedation is more for larger operations.  Many times I can do small liposuction areas with this type of anesthesia.  Liposculpture of small areas like the neck or arms can effectively be done this way in the operating room.  The patient is still monitored and an RN helps to monitor the patients vitals.   We use an IV and give a patient Versed and sometimes Demerol or Fentynl for the pain and relaxation.
Larger operations that i perform like body contouring, tummy tucks, breast augmentations or lifts require full anesthesia.  I am fortunate to work in an office with a fully accredited operating room with Board Certified Anesthesiologists.  The patients are safely put under anesthesia with state of the art monitors and anesthesiologists. 
Facelifts are done using a specialized technique.  We use sedation with Propofol.  Our patients are not intubated and not given a lot of narcotics. They are usually given a little Versed for anxiety and Fentynl for the pain.  Just enough to make them comfortable and relaxed so that the surgeon can perform the surgery. 
It is a technique that has been used for over 15 years at the Lasky Clinic and has been well established and recognized as safe and effective.  I am very wary of other surgeons who claim to do surgery under sedation and are not using safe medications.