I want to know all the pros, cons, and benefits of both local AND general anesthesia.

I'm scared to death of this procedure either way. I was introduced to local anesthesia by a plastic surgeron I am looking into. it seems like the better choice since I'm afraid of going under, but I'm also afraid of the pain that being awake may cause. can someone please tell me all the pros cons and benefits of each type of anesthesia?

Doctor Answers 13

Pros and Cons of Local versus General Anesthesia.

Interesting. Many of the surgeons answering your question have discussed the question of local versus general anesthesia in relation to breast augmentation surgery, but you actually have not stated what surgery you are contemplating. The reason is probably that this question comes up most frequently with breast augmentation. Depending on the type of surgery, it might be that local anesthesia is much more appropriate, while with another operation, general anesthesia would be the only way to go. So it really depends on what you're having done.

Let's start by examining your fears. It is perfectly normal to have some level of anxiety about both a surgical procedure and anesthesia. It is an appropriate response to a stressful process, and if you weren't at least somewhat anxious then I would be concerned. On the other hand, if you are truly "scared to death" of both the surgery and the anesthesia, then you probably shouldn't be having what I am assuming is elective cosmetic surgery. But let's assume you are motivated to have this surgery, and managing your fear of anesthesia is an important part of the process. I find that for some patients their fear of anesthesia is far greater than their concerns about the surgery.

Another part of the answer is also determined by whether you are talking about strictly local anesthesia only, or whether it is being done in conjunction with IV sedation, also know as "twilight sedation". Many surgeons will do a procedure under "local", but supplement the local with IV sedation to improve overall patient comfort. That is attractive to the patient, but it also significantly increases the risk element if not done carefully. Does the name Joan Rivers ring a bell?

It is also important to understand that there is no risk free anesthesia, including local. In our area there is a corporate type liposuction clinic that offers laser liposuction without using "risky" general anesthesia. However I am aware of at least two incidences in which patients have died from an overdose of local anesthesia in this clinic. Now I submit that death is a nasty risk, and having local anesthesia is not a guarantee of avoiding it. So it is a myth to state that local anesthesia is a safer form of anesthetic. While there are some risks with any type of anesthesia, a general anesthetic, in a healthy person, delivered by an experienced board certified anesthesiologist, is extremely safe. Your statistical risk of getting in a fatal automobile accident on any given day is much greater, however most of us jump in our cars everyday without thinking about it. So if you feel safe enough to drive regularly, then statistically you should feel safe having a general anesthetic. The problem is that our perceptions of risk get skewed, often by sensationalized reports in the media which are constructed to grab our attention. But they can lead us to draw inaccurate conclusions about the true risks of ways of doing things.

And there is another risk that gets hidden within marketing and self promotion. Your question includes a reference to a "plastic surgeon" who introduced you the option of local anesthesia. Have you looked into whether this surgeon is certified by the American Board of Plastic Surgery? Unfortunately today there are far too many unqualified physicians who have reinvented themselves as cosmetic or plastic surgeons but if fact have had little or no training in plastic surgery and/or safety in the operating room. Often these so called "cosmetic" surgeons will offer to do procedures under "local" anesthesia because they are not qualified, or have not made the investment in a fully certified operating room, where they can safely employ a board certified anesthesiologist to do general anesthesia. So all they can offer is local anesthesia, maybe with some sedation, but in an environment which doesn't have all the safety features in place to make it a truly safe environment. Yet they market themselves as doing procedures without "risky" general anesthesia when if fact they operate in a high risk environment. 

So the take home message here is that there are some risks with both local and general anesthesia, and the important thing is to choose a surgeon who is capable of providing either type of anesthesia and is appropriately matching the type of anesthesia to the procedure you are having in order to provide the lowest risk, and best outcome, while maximizing the patient experience. Please choose wisely. 


Kirkland Plastic Surgeon
4.8 out of 5 stars 52 reviews

I want to know all the pros, cons, and benefits of both local AND general anesthesia


Breast augmentation” operation is performed under general anesthesia and it takes to perform the procedure nearly 1 to 1.5 hours when it is performed by a team of plastic surgeons. It is really important to decrease the operation duration to give less anesthesia to the patient yielding a better postoperative period to the patient. You will be advised not to eat 6 hours before the surgery and that is all! You will get a physical examination by your surgeon and anesthetist. After the examination; we will prepare you for the surgery. You will receive a sedation in order to reduce the preoperative anxiety and fell yourself more comfortable.


Bulent Cihantimur, MD
Turkey Plastic Surgeon
4.9 out of 5 stars 90 reviews


Hello dear, thanks for your question and provided information as well... Every surgeon has their decisions about what anesthesia to use depending on how long the're going to put down a patient during surgery. At The Dominican Republic, most of the plastic surgeons use epidural block with sedation, when the patient doesn't feel anything and is completely sleeping during the whole process.. 

Tania Medina de Garcia, MD
Dominican Republic Plastic Surgeon
4.5 out of 5 stars 396 reviews

Local anaesthesia for Breast Augmentation

It is a good thing that you have concerns as it means you understand that breast augmentation surgery is a "real operation" and there are potential complications.

It is very common to be scared of having an anaesthetic of any sort, however you can relax in the knowledge that is extremely uncommon to have a severe complication due the anaesthetic.  

Breast augmentation surgery can be performed under local anaesthetic alone, local anaesthetic and sedation ("twilight anaesthesia") or general anaesthesia.

While it is possible to perform breast augmentation under local anaesthetic alone, this can be very uncomfortable and distressing, so generally some sedation would be administered too.  This is a common technique and is generally safe.  The main problem is that adjusting the dose of sedation can sometimes be difficult, as is injecting the ideal dose of local anaesthetic.  If the dose of sedation is too high, then there is a risk of interfering with your breathing, if it is too low, then the procedure can be uncomfortable.  If the dose of local anaesthetic is too high it can cause complications (including seizures and death) or if it is too low then the procedure can be painful.

I usually suggest general anaesthetic is the best option.  This is a very safe technique and allows maximal control of the physiological variables that occur with surgery.  Local anaesthetic is usually infiltrated in addition so that a light general anaesthetic is required and therefore recovery is quick and usually relatively painfree.   The only downside of general anaesthesia is that a qualified anaesthetist and an accredited hospital is required.  This may add to the cost of the procedure however often the difference is small, if any.

Kind regards,


Dean Trotter, MBBS, FRACS
Melbourne Plastic Surgeon
5.0 out of 5 stars 39 reviews

Local anesthesia vs general anesthesia

Thank you for your question.  Having surgery can be scary regardless of whether or not you go under general anesthesia.  You did not mention which surgery you are contemplating, but we would typically only do liposuction, smartlipo triplex, cellulaze or other minor procedures with local anesthesia.  This is usually for your comfort.  General anesthesia is typically very safe.  Rest assured that you would be in good hands with a certified plastic surgeon and surgery center with a board certified anesthesiologist.  I hope this helps.  Good Luck

Alan N. Larsen, MD
Atlanta Plastic Surgeon
4.6 out of 5 stars 55 reviews

Breast augmentation and anesthesia

Breast augmentation cis probably best down under sedation or general anesthesia. This is a very safe method. I think that local alone would likely be too painful.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Breast Enlargement Using Local Anesthesia vs General Anesthesia

We do sometimes see patients with your level of anxiety over going to sleep for surgery.  They fear anesthesia more than they are concerned about undergoing the surgery!
I tell my patients that my ability to achieve the best long term results for them is greater if they are completely asleep during the procedure.  Under pure local anesthesia even with oral sedation discomfort and reaction to the procedure may prevent the surgeon from achieving the best result possible.  I also explain to my patients that every patient who undergoes general anesthesia for their breast augmentation awakens at its conclusion wondering why the procedure hasn't been done feeling like they were only asleep for ten minutes.  When they learn that it's been completed they all smile and later state that if they'd known the anesthesia was going to be so easy they would have had far far less anxiety.
Conclusion:  Give yourself the best chance for a smooth surgical procedure with the best chances of good results and memories of it being easy by allowing for general anesthesia.  IMO it's safer and so much easier for all involved.  If you're unable to plan for a general anesthesia then I would suggest not doing the procedure.  Good luck with your choice and enjoy your results.

Jon A Perlman MD FACS
Certified, Am Bd of Plastic Surgery
Member, Am. Society of Aesthetic Plastic Surgeons (ASAPS)
Beverly Hills, CA

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 30 reviews

General Anesthesia

To put it in a nutshell:
Three of my primary concerns for my patients are:

1. Their safety.
2. Their results.
3. Their comfort.

If I use local anesthesia instead of general anesthesia, I have to sacrifice all three of these to some degree.

Bryan Criswell, MD
Charlotte Plastic Surgeon
4.9 out of 5 stars 65 reviews

I want to know all the pros, cons, and benefits of both local AND general anesthesia.

It is safer to have iv sedation in a certified outpatient setting like a plastic surgeons office than to drive to that office. Local anesthesia to perform a breast augmentation is highly ill advised. There is no way to perform the procedure without significant pain in putting in the local and then tolerating the pain of the procedure in areas that the local did not completely anesthetize. Not every idea is a good idea. This is a bad idea.

Robert Graper, MD
Charlotte Plastic Surgeon
4.4 out of 5 stars 27 reviews

I want to know all the pros, cons, and benefits of both local AND general anesthesia.

Thank you for the question.
Every surgeon will have his/her preference. I prefer the use of general anesthesia provided by a board-certified anesthesiologist. I have found that the use of general anesthesia is safe, comfortable for the patient, and predictably maintains a patient in a good position (without movement) during the procedure. I think the latter is important as we are trying to achieve as much symmetry is possible.
Equally important is your choice of surgeon. Physicians who are board certified in plastic surgery hold a certification with the American Board of Plastic Surgery (ABPS). This certification proves that the surgeon has graduated from an accredited medical school, has completed a residency of at least five years, has three years of experience in general surgery, is actively practicing plastic surgery for at least two years, and has passed mandatory comprehensive and written examinations. These surgeons are referred to as diplomats of the ABPS and have fulfilled the following requirements.
It is in the patient’s best interest to choose a board certified plastic surgeon. It is vital to your safety and the success of your cosmetic surgery that the surgeon you choose has the right qualifications, ample experience, and documented results of his or her work. ABPS diplomats have extensive skill and experience in a wide range of plastic surgery procedures.
There are a number of advantages in choosing a qualified and highly experienced Board Certified plastic surgeon to perform your cosmetic surgery. If there are any complications during surgery, an experienced plastic surgeon will be more adept at handling the situation. In addition, a plastic surgeon that has performed many cosmetic surgeries will have had more time to perfect his or her technique and results.

Reputable plastic surgeons should have privileges to perform cosmetic surgery procedures in the operating room at an accredited hospital, not just in the surgery center in their office. They work with a highly skilled team including, board certified anesthesiologists, nurses, and technicians to enhance patient comfort and to provide a peace of mind to the patient’s and their families.
During your consultation with a board certified plastic surgeon, ask to see before and after photos of actual patients who have undergone cosmetic surgery. The surgeon may provide you with a list of patients you may speak to as a reference for the doctor. To enhance your education regarding the surgeon, you may be introduced to some post-op patients as well during your visit with the surgeon. Most patients are willing to share their experience regarding their surgeon, the staff, hospital, and recovery.
Professional doctors will ensure realistic expectations and take the time to address your concerns. They will provide you with honest advice and encourage you to do your homework, talk to other patients, and make an informed choice. One of the most important factors in choosing a plastic surgeon is your personal comfort level with the doctor. You should feel comfortable asking questions about your cosmetic surgery procedure so that you can make an educated final decision on whether you would like to proceed with surgery.
I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.