General or Local Anesthesia for Erbium Laser Resurfacing?

My consultant wants me to have a general anesthesia for full face ebrium laser treatment, but I would prefer to have local anesthesia for the treatment instead? How is the pain under local?

Doctor Answers 18

IV sedation has sufficed for all levels of laser treatment

Selection of anesthesia should be directed by the level and intensity of the laser treatment. For superficial treatments, topical anesthesia suffices. For medium to deeper treatments, often local nerve blocks with oral analgesics/sedatives or IV sedation is required. Depending upon one's pain threshold and anxiety level, a general anesthesia may be requested for patient's comfort.

The only time I have utilized general anesthetic is if the patient is already under general anesthesia for another cosmetic surgery.  In my practice, IV sedation has sufficed for all levels of laser treatment.

Longmont Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

Anesthesia for Laser Resurfacing

Here is a brief outline of what anesthesia is needed for the different uses of the Erbium:YAG laser

  • Microlaser peel- topical numbing cream, must be on for at least 30 minutes before starting
  • Fractionated laser- topical for most, some people will need more sedation.
  • Deep full-face laser peel- heavy IV sedation or general anesthesia with injected regional blocks

I have done a deep laser peel on small segments (i.e. lips or around the eyes) with just injected medication.  You would either be really tough or just a glutton for pain if you did the deep laser on the entire face without sedation.  Although this is a general outline, there are some people who are particularly anxious and need oral Valium, injected regional blocks or even general anesthesia for even a microlaser peel.  Remember that if this is a nightmare experience for all involved, it's unlikely you'll be happy no matter how good the results. 

John Bitner, MD
Salt Lake City Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

Sedation at least...

You do need some form of sedation for full laser resurfacing, whether it be IV or GA, for fractional laser, 95% of patients can get away with just local numbing cream, but full erbium... you really want to be comfortable. If you are comfortable, it helps the physician as well, as we can concentrate better. 

Hope that helps

Dr Davin Lim

Davin Lim, MBBS, FACD
Brisbane Dermatologist
4.7 out of 5 stars 77 reviews

Erbium laser does not require general anesthesia.

I have performed thousands laser resurfacings, both CO2 and Erbium.  I have not seen the need to use general anesthesia since the introduction of the fractional lasers.  The most popular Erbium laser is the Fraxel Restore. It is a fractional laser and is easily done with a topical anesthetic in combination with oral sedation, typically Valium and Percocet.  General anesthesia is simply not necessary and introduces excess risk and cost.

Susan Van Dyke, MD
Paradise Valley Dermatologic Surgeon
4.5 out of 5 stars 35 reviews

Laser resurfacing anesthesia

The choice of anesthesia for laser resurfacing of the face is very much dependent on your own pain tolerance. There are parts of the face which are easily numbed with local anesthesia like around the mouth and the forehead. The cheeks are harder to make numb and need more injections.  Taking an oral pain pill before the procedure can help some also.  General anesthesia is probably the most comfortable way to do it, but you can do it with local anesthesia or sedation.

Hope that helps!

Josh Korman MD

Joshua Korman, MD
Mountain View Plastic Surgeon
5.0 out of 5 stars 22 reviews

General or local anesthesia for full face erbium resurfacing

Most erbium resurfacing procedures can be done without general anesthesia, just by applying a topical anesthetic cream about an hour before the actual resurfacing.

However, pain is a very subjective sensation, as people have different pain tolerance levels. 

The amount of pain with a procedure does depend on the depth of the resurfacing.  The deeper the penetration of the laser, the more painful the procedure will be, as there are more nerves deeper in the skin.  The deeper the resurfacing, the greater the expected results. The more aggressive procedures may require more than topical anesthesia. 

There are also techniques for doing local nerve blocks that will anesthetise large areas of the face, such as the cheek areas numbed by injecting lidocaine in the area of the infraorbital nerves.

I would recommend that you discuss the procedure with your doctor and talk about his/her reasons for general anesthesia. 

Emily Altman, MD
Short Hills Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

General or Local Anesthesia for Erbium Laser Resurfacing?

This is a difficult question because there are many factors that only your physician knows.  In general, I would go with the recommendation of your surgeon.  If you feel you would rather have local anesthesia, speak to him about it and have him explain to you why you are not a good candidate for this.  He actually may think that you prefer general and that is why he recommended it.  If you don't like the answer, you are entitled to get other opinions.  Laser resurfacing is commonly done under local anesthesia.

Sam Goldberger, MD
Beverly Hills Oculoplastic Surgeon
4.7 out of 5 stars 16 reviews

Need more than just topical anesthesia for full face Erbium!

I do a lot of deep Erbium full face resurfacing.  It is awesome and gives phenomenal results.  The amount of anesthesia is proportion to the depth of the laser resurfacing.  If the surgeon is doing a very shallow peel to just freshen up your skin, topical anesthesia is good enough.  However, deep resurfacing to really regenerate new skin, collagen, etc will require deeper anesthesia.  I recommend IV sedation with blocks.  I don't think general anesthesia is required.

Raghu Athre, MD
Houston Facial Plastic Surgeon
4.6 out of 5 stars 90 reviews

Pain-Free Laser Resurfacing

Erbium laser skin resurfacing can have dramatic results and can be done relatively pain free.  There are actually 3 options:

1.  General Anesthesia

2. Sedation

3. Local/topical anesthesia

I only use general anesthesia if the patient is going to the operating room for something else at the same time (a facelift, for example).  Sedation is a good option along with topical anesthesia, but not absolutely necessary.  Often my patients will take a medication by mouth before the procedure to help them relax.  Topical anesthetic cream is absoultely necessary if you are going to be awake.  There are different creams on the market, but the most important thing is to give it plenty of time to work. 

Andrew Winkler, MD
Lone Tree Facial Plastic Surgeon
4.5 out of 5 stars 9 reviews

Anesthesia for laser resurfacing

Anesthesia requirements for laser resurfacing will depend on the type of laser used and the patient's pain tolerance. If the laser is fractionated, topical numbing medicine and possibly nerve blocks can be used to treat the face. General anesthesia is very rarely used but still an option if a patient has a low pain tolerance.

D.J. Verret, MD
Dallas Facial Plastic Surgeon
3.9 out of 5 stars 14 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.