What is the best method of sedation for a tummy tuck?

Question

Hi - can someone provide clarity on the differences between "twilight" sedation and general anesthesia? I was reviewing some comments and someone specifically stated that twilight sedation was used and they believe it helped with their recovery process. Is one better than the other for a tummy tuck or does the method depend on the patient.is one safer than the other? Thank you in advance.

Keith Hodge, MD · Answer

My preference is a general anesthetic. I feel that my patients are more comfortable fully asleep. This also allows for muscle relaxation medication to be administered which helps during the muscle tightening portion of the procedure. The airway is also fully protected with monitoring of all vital signs to ensure patient safety and comfort. Good luck!

Sheila S. Nazarian, MD · Answer

Every surgeon has his or her own protocol. Typically, I prefer general anesthesia for a tummy tuck procedure. Discuss the best option for you with your surgeon. My best,
Dr. Sheila Nazarian
@drsheilanazarian on Instagram

Austin Hayes, MD · Answer

We use general anesthesia performed by board-certified anesthesiologists in an AAAHC accredited operating room. General anesthesia allows for relaxation of the abdomen, so that it can be tightened fully during the "muscle repair."

Steven J. Rottman, MD, FACS · Answer

Thank you for your question. I prefer to perform tummy tucks under general anesthesia. I believe it is necessary to have complete muscle paralysis to perform an appropriate rectus diastasis repair. This can not be done under sedation. Please discuss your options with a board certified plastic surgeon who commonly performs body contouring procedures. Ask to see before and after photos of their work. Hope this helps and good luck.

Paul Jason Skoll, MBChB, FRCS, FCS(SA)Plast · Answer

Each surgeon will have their preference. In my practice, we use a spinal anaesthetic, with light IV sedation using propofol, administered by an anaesthesiologist. The spinal  allows for muscle relaxation without the need for systemic muscle relaxants, and hence assisted ventilation, and may be helpful in lowering one's risk for VTE.

Richard J. Wassermann, MD, MPH, FACS · Answer

Hello and thank you for reaching out. Every surgeon has their own preferences, however, I choose to have my patients under a general anesthesia vs a "twilight" sedation. General anesthesia is a controlled airway, and gives the muscles a relaxation that helps with the plication of the abdominal muscles. Discuss both options with your surgeon of choice, and be sure to feel comfortable with the end choice. Best Wishes.

Arko Demianczuk, MD · Answer

Twilight anesthesia allow the patient to breath spontaneously and typically does not require a supported airway (intubation with s breathing tube). In a general anesthetic  there is a deeper level of sedation where mechanical ventilation may be required.  it is not possible to do a satisfactorybtummy tuck the under twilight anesthesia. Occasionally a spinal anesthetic can be done although this may be challenging as well, as one can not do a muscle repair as easily and the area under the rib cage may not be entirely frozen unless it is a "high spinal". I would have a discussion with your board-certified plastic surgeon as well as their board-certified anesthesiologist.

Peter A. Aldea, MD · Answer

The most important component in a Tummy Tuck is not the removal of excess skin but the complete tightening of the stretched and separates abdominal muscles. Although a minimal repair can be done with IV relaxation and injection of local anesthesia these repairs are always underdone and disappointing. Many of those performing such "Tummy Tucks" are non-Plastic surgeons who are not allowed on the staffs of outpatient facilities or hospital staffs which restrict operations only to those surgeons who are trained and certified in that field. ( plastic surgeons perform Plastic operations. Gynecologist perform gynecological operations etc). The best way to asses just how successful a tummy tuck was is to see before and after photos of women In a Diving Pose - arms forward, head tucked, bent at the waist with tummy relaxed. You should be able to see a remarkable flatness instead of a major sagging "Hammock sign". Anyone can fake a flat tummy standing in an After photo but it's much harder to hide in a Diving pose. Performing s Tummy Tuck under local anesthesia assures a disappointing result and persistent pooch because only general anesthesia permits the safe performance of the adequate tummy muscle tightening required to achieve abdominal flatness. Peter ALDEA MDMemphis, TN

Neil T. Chen, MD · Answer

Thank you for the question. An integral part of tummy tuck is muscle tightening of the rectus muscles to achieve the flap abdomen in addition the skin excision and tightening. To tighten the muscles properly, we need to relax the them briefly. This requires general anesthesia. Twilight anesthesia is simply inadequate.

Ronald V. DeMars, MD (Retired) · Answer

We use general anesthesia with airway control and protection for the patients safety and total comfort. Solid muscle repair is best done with the muscles relaxed and cannot be done with local and sedation. For this degree of surgery any anesthesiologist will tell you that a healthy patient is much safer with a general given by a board certified anesthesiologist than a local with sedation.

What is the best method of sedation for a tummy tuck?

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