When I finished my plastic surgery residency in 1999, my impression was most cosmetic and reconstructive plastic surgery had to be performed under general anesthesia. May be my attendings chose this method of anesthesia for convenience, or simply lack of information at the time.
However, many cosmetic and reconstructive procedures can be done under local anesthesia.
The advantage of such anesthesia is a higher safety level and less cost to the patient, while still maintaining the quality of work.
Over the past two years, I have performed many procedures under local/regional anesthesia without any complications or degradation in the quality of work or patient satisfaction.
The patient is given an oral medication, usually Valium with or without Vicodin. The area(s) to be operated on is then anesthetized and the procedure is performed. An example of cosmetic and reconstructive procedures which can be done are: upper and lower eye lid surgery, mole or skin lesion removal (local anesthesia only), otoplasty (ear set-back), liposuction, chin augmentation, mid and lower face and neck lift, breast lift or small volume breast reduction.
Examples of reconstructive procedures are: tendon repair of fingers, small lesions or cyst of the hand, local skin flaps for coverage of a shallow defect, some breast reductions.
Regarding breast augmentation and abdominoplasty (tummy tuck), I am aware of these procedures being done without general anesthesia. However, almost all patients require some form of intravenous sedation. This significantly alters the safety margin, as the patient may become overly sedated and require intubation (general anesthesia). For intravenous sedation, a board certified anesthesiologist or CRNA must administer the medication and the procedure should be performed in an accredited surgical center. I am constantly thinking of ways these procedures can be done safely without intravenous sedation. When I find a solution, I will definitely blog about it!
Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience. His office is located in central Orange County. To schedule a complimentary consultation, please call (714) 834-0101.
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