{"id":10502,"date":"2021-04-09T10:32:13","date_gmt":"2021-04-09T17:32:13","guid":{"rendered":"https://www.realself.com\/news\/?p=10502"},"modified":"2021-04-09T10:35:50","modified_gmt":"2021-04-09T17:35:50","slug":"twilight-sedation-anesthesia","status":"publish","type":"post","link":"https://www.realself.com\/news\/twilight-sedation-anesthesia","title":{"rendered":"Twilight Sedation: 8 Things to Know"},"content":{"rendered":"

Three years ago, Krystal Reilly elected to get a Brazilian butt lift<\/a> under conscious sedation. She was told it would be a simple, painless procedure that she’d likely sleep through. In actuality, she remained wide awake and only partially numbed. The pain was “horrific,” she recalls; before the fat transfer portion of the surgical procedure, she was handed stress balls—that’s how alert she was.  <\/p>

Needless to say, that’s not<\/em> how things should go. Done properly by a board-certified doctor and anesthesia provider (typically an anesthesiologist and\/or a certified registered nurse anesthetist) in a hospital setting or accredited surgical facility, twilight sedation, also known as conscious sedation or sedation analgesia, is a safe, pain-free anesthesia method for those who don’t want, or can’t have, general anesthesia.<\/p>

Surprisingly, Krystal’s first experience didn’t put her off from going under the knife again. When searching for someone to do her breast augmentation, she made sure to do in-depth research of both the twilight anesthesia method and the providers who offered it, to ensure her doctor was a board-certified plastic surgeon in good medical standing, with the highest safety standards. She ultimately settled on Dr. Randy Buckspan<\/a>, a plastic surgeon in Austin, Texas. “My twilight anesthesia experience was amazing. I wish more people knew how easy it is, because if you don’t need to go under general anesthesia, why do it?” she says.<\/p>

Find Doctors Near You<\/a><\/div>

Here, the top eight things to know if you’re considering twilight anesthesia for your cosmetic or dental procedure.<\/p>

1. Twilight sedation can be used safely for almost all cosmetic surgeries, but doctors have differing preferences on anesthesia methods.<\/h2>

For Krystal, it wasn’t easy to find a board-certified plastic surgeon with an accredited surgery facility and no malpractice cases or deaths on their record who offered twilight sedation for breast augmentation<\/a>. “I called so many doctors in the Austin, Texas, area, many of whom noted on their website that they did twilight, but when I got them on the phone, they’d say they didn’t do it unless it was medically necessary,” she says. “They made it seem like I wanted it just because I was cheap [and wanted to save on anesthesiologist costs], when really I was just fearful of general anesthesia.” [According to two plastic surgeons and two anesthesiologists we spoke to, there is no savings for choosing twilight over general, since an anesthesia professional should still be present throughout the surgery.]<\/p>

According to Dr. Deborah Platt, a board-certified anesthesiologist in Great Neck, New York, “Most doctors prefer patients undergo general anesthesia, to protect their airways from the start of the procedure, instead of the possible introduction of a breathing tube during the procedure, should one be called for—which is rare. Before any decision on type of anesthesia is made, patients undergo a full medical workup. Oftentimes, a larger patient might be less of a candidate for twilight anesthesia, due to anatomical airway issues.”<\/p>

At Dr. Buckspan’s practice, where Krystal eventually ended up getting her surgery, the doctors use twilight sedation only<\/em>—for everything from tummy tucks to facelifts. But general anesthesia, he admits, can be simpler: “The patient’s not going to move, they’re going to be out in a few minutes and it doesn’t take as long to get through an operation.” It’s been around forever and works well, he says, so there is no major incentive for doctors to explore other options. Dr. Buckspan personally feels twilight is the safest and most comfortable type of sedation available, which is why he uses it exclusively.<\/p>

Dual-board-certified facial plastic surgeon Dr. Andrew Jacono<\/a>, who works with Dr. Platt, estimates that the majority of procedures he does are performed under twilight anesthesia and says that “while the risks of having serious complications after general anesthesia are extremely low [less than .001%], there is no question that the rate of nausea, the discomfort and the increased bruising and swelling associated warrant the many plastic surgeons who will perform surgery only under general anesthesia to reconsider their approach.”<\/p>

Of course, there are limits to when twilight can be used: “Certain surgeries can be done solely under general anesthesia, such as extensive body work, intra-abdominal surgeries where muscle relaxation is warranted or complicated rhinoplasties,” says Los Angeles–based board-certified anesthesiologist Dr. Shahin Ebrahimian.<\/p>

Related: What 10 Plastic Surgery Patients Would’ve Done Differently, Had They Known Then What They Know Now<\/a><\/em><\/p>

2<\/strong>. You are conscious and able to breathe without assistance.<\/strong><\/h2>

Though general anesthesia is considered to be very safe, many people don’t like the idea of being put into a medically induced coma and have concerns about the side effects and risks. “Under twilight sedation, your body is awake but your mind isn’t,” says Dr. Buckspan. “You’re breathing, swallowing, coughing, sneezing—only you aren’t aware of anything that’s going on and can’t feel any pain or discomfort.” Many patients tend to fall asleep once the medication kicks in.<\/p>

“I just felt very relaxed and tired, like I’d had a long day at work,” says Krystal. “I remember talking about Beto O’Rourke and saying I loved him, then mid-conversation—boom<\/em>—I was out, like a snap of the fingers.”<\/p>

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