Anesthesia in Plastic Cosmetic Surgery

CEBU, Philippines - One of the most frequently misunderstood aspects of cosmetic surgery is not about the surgery itself but about anesthesia during the operation. This is because, almost always, the question that patients ask is whether the surgery or recovery is painful or not. It is the type of anesthesia used that determines whether the patient will have a pleasant or horrible experience. Very few patients realize that in cosmetic plastic surgery, the choice of anesthesia is also very critical. Most of the morbidity/ mortality or accidents in cosmetic surgery are actually related to anesthesia. This means the right anesthesia technique was not applied.

A good example is when a patient for liposuction has low tolerance for pain yet the doctor would still perform the procedure under local anesthesia with or without light sedation. Since the doctor thinks that the operation is minor, he would do it in an office setting without the help of an anesthesiologist. For sure the patient would be squirming about when the lipo is done. The tendency of the doctor is to do a lesser liposuction or increase the dose of the local anesthetic or increase the sedative. These have led to fatal accidents due to overdose of the medication. As the patient complains of increasing pain, more local anesthesia is given resulting in an overdose and the doctor doesn’t have the right monitoring or resuscitation equipment and training to deal with the overdose.

Something might also happen when a patient who needs eyebag surgery, which can be done under local anesthesia, is put to sleep under general anesthesia without the proper preparation or support equipment. Patients may vomit and aspirate the vomitus into the lungs and die. If the patient can tolerate the operation comfortably, a local anesthetic technique should suffice to avoid the possible complications of putting the patient to sleep.

Local or general anesthesia? This issue is more confusing because a lot of people think that general anesthesia is more dangerous than local anesthesia. This is not always true. As a matter of fact, in my practice, I find general anesthesia much safer in certain instances. For example, patients who have an operation for more than 3 hours, or patients who have unstable blood pressure or patients who have to be turned from side to side are better off and safer when they are under sedation or general anesthesia.

It is very important to understand that complications in anesthesia can occur whether local or general anesthesia technique is used. Accidents are usually the result of incompetent practitioners or practitioners who give anesthesia without the proper equipment available. The operating room should have all the equipment and medications available to handle all emergencies. A well trained, Board Certified anesthesiologist will make sure that the patient is well prepared for the type of anesthesia to be given, as well as the surgery that is going to be done. He makes sure that the patient is not allergic to drugs he is going to use and that the patient has complied with all pre- operative instructions given. Most important of these is that the patient did not eat or drink anything 6 hours prior to the anesthesia in cases where patients are put to sleep. He also double checks that laboratory results are normal and the heart and lungs of the patient are healthy enough for the operation and for an uneventful recovery.

During the operation, a good anesthesiologist monitors his patients like a hawk, he is aware of problems before they happen. If accidents do happen, he is well trained and equipped to handle them. He works in perfect harmony with the surgeon making sure the conduct of the operation is as safe as possible. He does not hesitate to tell the surgeon not to proceed with the operation if he senses something awry with the patient.

A good anesthesiologist is also someone who makes sure the patient has a pleasant recovery. He makes sure that he is always available for consultation even when the patient is sent home right after surgery. Together with the surgeon, he should always be there to address the patients and relatives concerns about recovery.

Patients should always remember that a Board certified Plastic surgeon would allow only a Board certified anesthesiologist to handle his cases. So your selection or choice of surgeon practically determines your choice of anesthesiologist.

When considering any cosmetic surgery, think like a doctor. Safety first before anything else.