Twilight Sedation vs. General Anesthesia for Multiple Cosmetic Procedures?

I am having my nasal dorsum filed, submental lipectomy, and a chin implant placed all at once. My surgeon said the whole surgery should last approx. 1.5 hours, and has given me the option of twilight sedation or general anesthesia. Obviously the general anesthesia is quite a bit more expensive, and also increases recovery time, but I'm nervous about being conscious of the procedures being done to my face. Any suggestions regarding potential complications of either method?

Doctor Answers 4

Twilight vs. general anesthesia for multiple operations.

For 35 years that I have performed multiple cosmetic surgeries I have found that more than 95% of patients prefer to be totally asleep. Therefore, I think that besides controlling your airway and a minimal difference in recovery that general anesthesia is preferable.

Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Choosing anesthesia for plastic surgery

I personally would not give you the option of twilight sedation. Some surgeons are comfortable with it and can do these procedures under sedation without difficulty. I am not and cannot. The lay person thinks sedation is safer than general anesthesia but I can tell you that my anesthetist would refuse to do sedation for these procedures. Patients prefer sedation because they feel they retain some control over themselves, save money and have a quicker recovery but in reality they take some control away from the anesthesia staff and are usually not fully capable of handling that control during surgery. Also my anesthetist charges by surgery time so he would charge the same for general anesthesia or sedation. I personally do not sedate patients and no one should unless they are Advanced Cardiac Life Support (ACLS) certified. In fact that is the state law in California.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 1 review

Anesthesia risks.

I personally prefer to have my rhinoplasty patients under general endotracheal anesthesia so that the responsibility for the airway and the patient's safety if that of the anesthesia professional. I can concentrate my attentions better on the fine points of the surgery. Alternatively, I prefer to perform facial and neck liposuction and chin augmentation under sedation and local anesthesia as I have better visualization of the areas involved without concerns for the anesthesia tube being in my way or it being dislodged from the head turning maneuvers I use. In your case , I would do the chin and neck work first under sedation and local and then do the rhinoplasty last under general endotracheal anesthesia.

Your surgeon should do what is most comfortable for him/her and you and what is best for your safety.

Sheldon S. Kabaker, MD FACS
San Francisco Facial Plastic Surgeon
4.4 out of 5 stars 35 reviews

Complications of anesthesia

Nobody wants to take unnecessary riks with anesthesia and because of that "twilight" sounds less dangerous to the patient.  Many times it is MORE dangerous though because if you are nervous, the sedation won't work as well as you fight it with anxiety.  Also, if you are sedated enough to be asleep without your airway protected as it would be in a general anesthetic you could be at risk too. 

In your case, blood can get in your throat from the nasal surgery and this would be very unpleasant under twilight.  Pay the extra for greater sfaety and comfort of a general anesthetic.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 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.