A Guide to Anesthesia for Cosmetic Surgery

Thinking about having cosmetic surgery? Then there’s no harm in knowing all your options for a pain-free and perfectly pleasant experience.  With all the hype over “awake” procedures nowadays, we thought a quick Guide to Anesthesia for Cosmetic Surgery might prove useful.

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1. Local Anesthesia

  • PROCEDURES- Dermabrasion, Laser Skin Resurfacing, Filler Injections

local anesthesia, cosmetic surgery, plastic surgery, breast augmentation, liposuctionThis is the most basic type of anesthesia and should only be used for the most basic procedures. You get an injection of numbing medicine (like novacaine) at the surgical site and once it takes effect, you shouldn’t feel any pain. You will still be able to feel sensations like pulling and tugging, and since you don’t get any intravenous medications, you are totally awake for your procedure. Local anesthesia is appropriate for small procedures that can be done in the office setting, like dermabrasion or filler injections. Since the average needle is about 2″ long, you can only numb an area as large as a 4″ circle with a single injection. That means if the surgical area is larger than 4″, you will have to receive multiple injections, and you’ll feel every one!  While it is true that you can make large areas numb for “awake” surgery, the process of getting to that point can be pretty uncomfortable. So, the next time a surgeon offers you an awake breast augmentation, dig a little deeper before you make a final decision.  Don’t forget… if it sounds too good to be true, it probably is!

Check out this recent article in the New York Times about awake breast augmentations. As you’re reading, first notice that the doctors who offer this technique are NOT plastic surgeons, and are therefore NOT qualified to offer this type of surgery. Second, take note of one of the comments made by Dr. Gandhi (a general surgeon who performs cosmetic surgeries in an unaccredited facility): “Patients can scream and I would know I can’t be putting my needle there.” Hmmm… not sure I like the idea of screaming during surgery.  Thanks, but no thanks Dr. Gandhi!

2. Local Anesthesia With Sedation

  • PROCEDURES- Ultra-Small Volume Liposuction (neck, knees), Blepharoplasty (eyelid surgery), Brow Lift, Scar Revision, Fat Transfer

local anesthesia, cosmetic surgery, plastic surgery, breast augmentation, liposuction


If  the area you’re having surgery on is big enough to require multiple injections, adding sedation to the mix may be a good option to keep you comfortable. You’ll get an IV in your arm and you’ll receive medications (like propfol and versed) to make you sleepy (the “sedation”) so you won’t feel all of the injections ( the “local”). After about 20 minutes, the sedation will begin to wear off, and you’ll wake up, but you won’t feel pain. Remember though, once you wake up, you will be aware of tugging and pulling sensations, and of everything going on around you. While there’s nothing wrong with an operating room, it’s probably not the most enjoyable place to hang out while getting poked and prodded, so this method of anesthesia is still best for shorter procedures that take less than an hour.

3. “Twilight” Anesthesia

  • PROCEDURES- Small-Volume Liposuction (single area), Short-Scar Facelift, Neck Lift, Otoplasty
local anesthesia, cosmetic surgery, plastic surgery, breast augmentation, liposuction


You’re getting sleepy…verrry verrry sleepy! Once again,  you will receive the same sedative medications, but this time, they will be running continuously through your IV. Even though you will be out cold, you won’t have a breathing tube. Be careful though… it’s a very common misconception that not having a breathing tube is a safer way to have surgery. This is not always true, and here’s why.

When you are under anesthesia, you have no gag reflex, and you are lying flat on your back on the operating table. Have you ever tried to take a sip of water lying flat on your back?  Bad idea, right?  It’s going to go down the “wrong pipe” and make you choke and gag all over the place.  Well, imagine if you were sleeping and someone poured water down your throat.  Some of it might make it down the right tube, but a good portion of it is going to go down your windpipe into your lungs. If you aren’t drugged up, you will still cough and gag to get most of it out before it causes a serious problem like hypoxia (lack of oxygen) or pneumonia.

When the drugs take away your gag reflex, you don’t choke or gag.  So, any saliva or food particles in your stomach can travel down into your lungs, which is bad news if you’re lying there for a while. In situations like this, having a breathing tube in your windpipe is a MUCH SAFER strategy because it prevents everything except air from traveling into your lungs. You’re probably starting to notice a trend here…. if the procedure is longer than an hour, a breathing tube and general anesthesia are probably the way to go.

4. General Anesthesia

  • PROCEDURES- Facelift, Breast Augmentation, Breast Reduction, Liposuction (large or multiple areas), Abdominoplasty (Tummy Tuck), Brachioplasty

local anesthesia, cosmetic surgery, plastic surgery, breast augmentation, liposuctionThis is the real deal: the best pain killers, continuous anesthesia, and a breathing tube to protect your lungs. For procedures longer than an hour that involve surgery on a large area of the body, or for procedures that involve sensitive deep tissues below the skin, this is the best option to maximize safety and comfort. Instead of screaming to tell Dr. Gandhi that his needle hurts, and instead of having your lunch travel into your lungs, you fall asleep gently, you take the best nap you’ve ever had, and you wake up in the recovery room without ever feeling a thing. If you’re a healthy person, general anesthesia is by far the safest option for most cosmetic procedures.  If you want to worry about something, worry about whether or not your doctor is qualified to be doing your operation!

Your Anesthesiologist: The Most Important Factor in the Sedation Equation

local anesthesia, cosmetic surgery, plastic surgery, breast augmentation, liposuction


An anesthesiologist is an expert at keeping you comfortable, protecting your lungs, and protecting your heart. If a rare emergency like an arrythmia or allergic reaction should occur, your anesthesiologist is skilled in administering the appropriate care to keep you safe. They are even better than your Plastic Surgeon for managing emergencies, and definitely better than doctors with no surgical training who are pretending to be surgeons!  They add a little extra cost into the operation, but they’re worth every penny.  Think about it this way… if your surgeon thinks your surgery is a big enough deal to take you to the operating room, then why skimp on anything… especially the anesthesia!

Sweet dreams!

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nicholas vendemia on facebook, mas, manhattan aesthetic surgeryNicholas Vendemia, M.D.
Plastic Surgeon, New York City
MAS / Manhattan Aesthetic Surgery

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Photo Credit: CREDIT

NOTICE: None of the celebrities or individuals discussed here have ever received treatment, surgery, medical advice, or evaluations from any author, physician, surgeon, or representative of this blog. All images and photos in this article represent models only. No actual patients or clients are shown.

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