Which type of anesthesia is the safer option for controlled epilepsy patients?

If someone is in status epilepticus, general anesthetic is sometimes the preferred treatment. You would require clearance from your neurologist, however, it should not be an issue. We utilize general anesthetic in all of our rhinoplasty patients to prevent blood from inadvertently entering the airway and causing an aspiration pneumonia. Surgeons may utilize intravenous sedation, however, this is not our preference over 25 years. Thank you. Sincerely, Dr Joseph

Hello, general anesthesia is sugessted for epilepsy patients. During the surgeries with local anesthesia seizure may be triggered

Your surgeon should discuss this with the anesthesiologist. I’m sure the anesthesiologist has experience with epilepsy patients and can get you through this safely

Thank you for the question. You are very safely monitored under general anesthesia, which is the technique for almost all rhinoplasty cases. The medications given during this procedure are often the same used to treat seizures, so if your epilepsy is well controlled, a seizure during the procedure is unlikely.

I think the first step is to talk to your neurologist, then with your plastic surgeon.
If you haven’t selected a plastic surgeon, then you have a fairly substantial job ahead of you.
My best guess is that many plastic surgeons may prefer to have an anesthesiologist there for giving you the sedation and monitoring you during the procedure.
They can give you sedative drugs that lowers seizure threshold protecting your brain from having an adverse outcome during the operation.
Plastic surgeons could do this as well, but I think the job is better done by an anesthesiologist.
Your neurologist may also have some input about your seizure threshold, medication’s, and giving clearance, which might be nice for your plastic surgeon.
If you’ve not selected a plastic surgeon, then this is an important topic.
Rhinoplasty surgery is fairly complex and mastering this procedure does not happen by finishing residency in plastic surgery.
Look for senior providers, who have at least one or two decades of experience, preferably plastic surgeons who specialize exclusively in rhinoplasty surgery.
If you’ve selected a plastic surgeon and are not interested in changing providers, then you can ignore the rest of this response.
It doesn’t really matter if they have a plastic surgery, background or facial plastic surgery background what really matters is if they have experience and Deliver consistent quality work.
Plastic surgeons who do occasional rhinoplasty surgeons or most likely have far more inconsistent results with higher patient, dissatisfaction, revision requests, or revision rates.
You really want to avoid needing a revision after a rhinoplasty.
This is very much one of those procedures where you should do it once and do it right.
to find the right provider I suggest looking for plastic surgeons or facial plastic surgeons who seem to focus their practice strongly on plastic surgery preferably exclusively.
Their website will most likely indicate this.
The number of before and after pictures website should also be indicative of what type of surgery they do the most.
Once you have a list of names, then I suggest scheduling multiple in person and consultations.
I do not recommend people having only one consultation, then scheduling surgery. Doing so basically eliminates the ability to choose the better provider.
I do not think patience can adequately Judge or vet plastic surgeons without in person consultations.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of people with very similar facial/nasal characteristics. An experience provider should have no difficulty showing you the before, and after pictures of at least 50 previous patients.
Being shown only a handful of pre-selected images, representing only the best results of the providers career is insufficient to get a clear understanding of what average results look like in the hands of each provider.
Likewise, rhinoplasty is not an operation. It is a general term for many many different operations used to alter the shape of various parts of the nose.
You want to see before and after pictures of patients who had the same combination of procedures that you did.
For example, if the doctor is recommending dorsal hump production with definition of your nasal tip, then you should be seeing before and after pictures of patients who had that procedure.
In reality a highly experienced plastic surgeon who specializes in rhinoplasty surgery should’ve access 100s or preferably thousands of before and after pictures.
Ask yourself why somebody doesn’t have an endless collection of pictures if they claim to be experienced and good at doing an operation.
This is the number one and the biggest red flag.
I also recommend you ask providers what the most common reason for revision surgery is, what their revision rate is, and what the revision policy is.
Rhinoplasty surgery is quite notorious for having a fairly high revision rate so some revisions is normal, and all providers should have a certain revision rate.
Even the very best providers in our field do revisions from time to time.
Providers who claim they have a zero revision rate, probably means they are dismissive of patients unhappy outcomes.
Don’t schedule surgery at the end of the consultation.
Finish all the consultations you had on your list of providers and never schedule on the day of the consult.
If somebody offers you a special deal if you sign up early or they just happen to have an open spot this week then that should generally be a red flag.
Surgical schedules do change and are quite dynamic and once in a while there are openings but if people are encouraging you or trying to sell you on surgery then be aware of what’s happening.
Some plastic surgery offices use quite aggressive sales tactics.
Other providers are pure patient advocates, and are simply into it to give you the best outcome and be a supportive provider.
Having a lot of reviews, having published books, been on television, being a professor or other accolades are unrelated to doing surgery don’t have any impact on someone’s ability to be a better surgeon.
I think your seizure disorder will not be an issue, but may require a bit of communication between your neurologist and our plastic surgeons, and if the procedure is done with you awake they may still be at good indication for having an anesthesiologist present.
Good luck,
Mats Hagstrom