Is twilight sedation + epidural safe and common?

Question

I am in the process of finding a PS for a BBL. I had a consultation with a highly reviewed board certified, plastic surgeon. This surgeon uses what he called, "Twilight sedation + epidural". I have never heard of this. Is this safe? Is the common?

George Marosan, MD · Answer

Thank you for your question. Twilight sedation can mean different things to different surgeons. I think there's nothing wrong with this approach, I personally do not use it. Takes extra 30-45 minutes to place an epidural and takes time to recover until you get full sensation and function back to the lower extremities. I prefer deep intravenous sedation by my anesthetist and tumescent solution into the fat compartment. The deep sedation negates the use of the epidural and its potential risks and complications. In my body sculpting approach, I remove fat over the mid to lower back back bone creating a nice muscle definition. With an epidural in place, one cannot do that.  My patients are ready to be discharged from the clinic 20 minutes after a total body sculpting and fat transfer to the buttocks.
See a board certified plastic surgeon experienced in advanced body sculpting techniques for an in person consultation/evaluation. Good luck. See attached web reference.

Kenneth Hughes, MD · Answer

Spinal/epidural anesthesia has some advantages over general anesthesia. Many patients who fear not waking up prefer spinal/epidural anesthesia. Since you don’t “go to sleep” there is no waking up so the immediate recovery part is a little easier. You may have a headache as a result of the epidural. 
You do not necessarily need general anesthesia, but I do think it is a better patient experience. I have performed many of these procedures with local and sedation, but it is certainly not for everyone and risk benefit analysis must be performed for each patient. You want the most dramatic transformation possible, and you do not want to be in pain.

Mats Hagstrom, MD (license on probation) · Answer

Most plastic surgeons US general anesthesia for a BBL.

Personally I prefer local anesthesia with mild sedation.

There’s a pretty steep learning curve for how to get to patients through this procedure without significant discomfort without general anesthesia.

An epidural may be an option. It should not be particularly high risk but all procedures including anesthesia come with some risks.

Personally I would focus my efforts primarily on finding the best and most experienced provider and let that provider choose the form of anesthesia for me.

Having a lot of reviews typically indicates a plastic surgery practice that has aggressive marketing campaigns.

The one single variable I found found consistent with plastic surgeons whom I admire and respect is a lack of justified negative reviews.

When I look at the profiles of the plastic surgeons I think are the best in the field they often have surprisingly few reviews but consistently did not have justified negative reviews.

The following are some general recommendations for patient seeking cosmetic surgery.
1. I recommend patients avoid traveling long distances for elective surgical procedures. There are of course instances where there is a lack of local talent and traveling to some degree is inevitable. If traveling for the procedure patients should be ready to travel to have the consultation, post operative appointments and follow up should there be issues or complications.
Patients sometimes do not appreciate the importance of in person consultations, that complications do happen or the number of people who have issues with their results or need revisions.

2. Schedule multiple consultations with different providers in your area who seem to have a good reputation for the procedure you’re interested in. Starting with at least five consultations seems like a reasonable number to me.

3. Whenever possible schedule in person consultations.  
4. During in person consultations ask each plastic surgeon to show all of their before and after pictures for the procedure you’re interested in.

The goal is not to see the best results of their career but to get an idea of what average results look like and get some type of confirmation of how many of these procedures that provider has performed.

Ask to see results that were not as good as the doctor would’ve hoped for and talk about the differences in outcomes.

Honest and experienced providers should have no problems presenting this type of information.

A highly experienced plastic surgeon should have hundreds of before and after pictures for the procedure you’re interested in. At a minimum at least 20+.

5. Read all the reviews on various physician review websites paying close attention and avoiding providers with any significant number of justified negative reviews.  Providers with an abundance of reviews often have aggressive marketing campaigns.

The plastic surgeons I respect most all have the single variable of not having justified negative reviews on their online profiles. 
In my opinion justified negative reviews are far more telling than an abundance of positive reviews.

6. Avoid scheduling for surgery or making a deposit on the day of the consultation.  Give yourself some time to think about the decision and make sure you finished all scheduled consultations before committing to having surgery that will permanently and irreversibly change your body.

When in doubt slow down and schedule more consultations.

Choosing the right plastic surgeon is the single most important variable to having a positive experience.

7. Don’t go chasing after technology or names of certain equipment. Instead focus all your efforts on finding the most experienced and talented board-certified plastic surgeon.

Best,

Mats Hagstrom MD

Is twilight sedation + epidural safe and common?

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Is twilight sedation + epidural safe and common?

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