For many patients considering cosmetic surgery, one of their major concerns is the type of anesthesia that will be used. “Will I need to be completely knocked out?”, “What if I don’t wake up?” are among some pretty standard questions I hear during the consultation. To better answer these questions, let’s agree on the terminology first.
General anesthesia is the process of sedating the patient to the point that they are so relaxed that you need to support their breathing with a breathing tube placed into the mouth (I’m trying to explain this with the most gentle of words!). While general anesthesia is very safe, it can cause a sore throat from the breathing tube or lower the blood pressure during the procedure.
Conscious sedation, twilight or monitored anesthesia care (MAC) all describe the same thing – anesthesia where you’re breathing on your own but pretty much unaware of what’s going on. This type of anesthesia, if possible for your procedure, is really the best of both worlds. You’re asleep and comfortable but not relying on a machine to help you breathe. I find that patient’s blood pressure is more stable during this type of anesthesia. This is the type of anesthesia typically used for a colonoscopy.
Since you’re not as “out of it” with MAC as you are with general anesthesia, you need “numbing medicine” (lidocaine, novacaine, xylocaine are all types of numbing medicine) injected into the areas where incisions will be made if you’re having your procedure done under conscious sedation. This is the main limitation of conscious sedation. If you are having a large procedure like a tummy tuck where the abdominal wall will be tightened, it’s hard to inject enough lidocaine to get you numb enough to tolerate the procedure under conscious sedation. And there are risks of heart irregularities when using too much lidocaine. Additionally, to tighten the abdominal wall muscles during a tummy tuck, the patient needs to be really relaxed and this can only be accomplished if the patient is paralyzed, which is done during general anesthesia.
So which type of anesthesia will be used depends on the procedure you are having and the comfort of your doctor. Many doctors will perform a facelift under general anesthesia but I’ve become more comfortable with conscious sedation for this procedure. Even though a facelift seems like a big procedure, conscious sedation allows the blood pressure to remain stable during the procedure and reduce the risk of bleeding postoperatively. Also, since the face is a pretty small area, you can numb up the skin pretty easily with a diluted concentration of lidocaine which provides numbness without the heart risks. Upper eyelid lift, breast augmentation and liposuction are other procedures that can be done under conscious sedation/MAC. I think patients would prefer conscious sedation when appropriate because of the decreased risk of nausea and vomiting afterward and the ease with which you wake up as compared to general anesthesia. While I wouldn’t recommend operating heavy machinery or driving a car, you’re definitely less groggy after a procedure under conscious sedation.
The take home point here is that anesthesia has become safer and safer over the years so whichever type you use, chances are you’ll be fine. But with this caveat: be sure your cosmetic surgery is being performed by a board certified plastic surgeon and the anesthesia is being performed by a board certified anesthesiologist. Complications can always occur but I’d rather have the most highly trained personnel there to help see me through to another day!