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Safety, Anesthesia and Awake Cosmetic Surgery

A popular new women’s health article on msnbc.com investigates “bargain plastic surgery” under local anesthesia. “Nipped, tucked and wide awake?” is a thorough investigative article that offers some keen insight about an alarming cosmetic trend.

In response to the article, we asked Dr. Cuzalina a few questions about the topic of “Awake cosmetic surgery.”

When is the right time for local anesthesia, i.e. an awake operation?

Awake anesthesia has its place for many types of surgery and some cosmetic surgery procedures.  However, it should be a joint decision between the patient and the surgeon. The best anesthesia takes in account both the level of safety it offers in a particular case and the comfort of the patient.

Sometimes a local or supplemented local anesthetic make be a great option for small isolated procedures such as small areas of liposuction or isolated eyelid surgery. But I personally feel it is better to perform most cosmetic surgeries under an anesthesia (IV sedation or general anesthesia) using a separate anesthetist or anesthesiologist.

The patient does not have to feel any intra-operative pain and the surgeon can concentrate on doing a good job rather than worrying about controlling patients fear or discomfort.  I simply do a better job in most cases if my patient is totally comfortable under anesthesia control.  No anesthesia is perfect and there is a slightly higher rate of nausea after general anesthesia compared to local or sedation.

However, large volume liposuction or other ‘big’ procedures under local anesthesia can potentially be more dangerous because of the chance of lidocaine toxicity, an overdose of the local anesthesia used to numb the patient while awake. Under general anesthesia, less lidocaine is needed.

Are operations like breast augmentation and liposuction being performed under local anesthesia in the Tulsa area?

In Tulsa, as far as I know, no one is doing breast augmentation under purely local anesthesia. But, there are several that do perform liposuction only using local anesthesia or supplemented with light sedation. Patients should keep in mind that it may be very uncomfortable and even risky to undergo large area liposuction under local anesthesia.

Ultimately, the surgeon should help guide the patient for the most suitable choice in anesthesia.  If your doctor has only ever used one technique, they may not know which is actually best.  More and more, doctors from non-surgical backgrounds are beginning to perform cosmetic procedures such as liposuction.  While many may have gone for additional training and do a good job for certain procedures, patients must be diligent to research their treating doctor and verify credentials regarding education, training and experience.
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