Was it necessary to have twilight sedation for Basal Cell Carcinoma surgery if my BCC was 4 layers deep?

It is up to every physician for how to do each patient's procedure. If your Mohs surgeon thought it best for you to see a plastic surgeon for your repair, I'm sure that was necessary. The plastic surgeon probably does almost all surgeries in a surgery center with some kind of anesthesia. It was the best option those doctors saw to treat your cancer and the site for the best possible outcome. Each Mohs surgeon will have their own way of performing treatments. I have extensive closure experience so I don't ever need to send my patients to a plastic surgeon for a repair, but not all doctors are as comfortable with grafts and larger procedures like this. Each doctor, like each patient, is unique. "This answer has been solicited without seeing this patient and cannot
be held as true medical advice, but only opinion. Seek in-person
treatment with a trained medical professional for appropriate care."

Absolutely not........I have been sending these cases to mohs' surgeons for years who do it under local anesthesia only. And I have been doing the follow up repairs including complex grafts under local anesthesia also quite easily and safely in my office operating room.