General or Local Anesthesia for Erbium Laser Resurfacing?

Question

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?

John Bitner, MD · Answer

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.

Sonia Badreshia-Bansal, MD · Answer

We never use general anesthesia for resurfacing. We use a combination of topical and local blocks. If you can tolerate the locals given at the dentist, then you will do just fine without a general anesthetic.

Stephen Prendiville, MD · Answer

The need for anesthesia is directly correlated with the aggressiveness of the treatment.  I have used intravenous sedation for aggressive fractionated CO2 laser resurfacing, and have in the past used it for erbium laser resurfacing.  General anesthesia (intubation) for laser resurfacing is probably overkill. 

	For a micro-laser peel,  topical anesthesia is sufficient.  In the right patient, an moderately aggressive fractionated CO2 laser treatment can be accomplished with topical anesthesia and nerve blocks.  However, the majority of my patients who wish to have substantial change for facial rhytids opt to have intravenous sedation with nerve blocks.  In addition, resurfacing is frequently combined with other procedures, making the entire set of procedures more anxiety free and less painful.

Boris M. Ackerman, MD · Answer

Only in a rare instance would general anesthesia be required for a full face resurfacing, and highly unlikely to be needed for an erbium laser. In our practice we use anything from numbing cream, to nerve blocks +/- sedation. It all depends on the desired goals, laser setting parameters, etc. It takes knowledge and experience to design optimum resurfacing plan for each individual patient.

Peter Schmid, DO, FAACS · Answer

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.

Susan Van Dyke, MD · Answer

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.

Emily Altman, MD · Answer

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.

Sam Goldberger, MD · Answer

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.

Raghu Athre, MD · Answer

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.

Andrew Winkler, MD · Answer

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.

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