LOCAL ANESTHESIA (see
used for minor or touch up procedures only.
A recent New York Times article featured non-plastic
surgeons who were promoting Breast
Augmentation » under
local anesthesia only In their offices. While this surgery
can be done with local only, it can be a very uncomfortable
and unpleasant experience. On the other hand, local anesthesia
when carefully administered and monitored twilight sleep
is both comfortable and safe. Type of anesthesia to use
is but one of many factors to be considered when contemplating
this surgery, it should not be the primary one.
In fact, this is the reason it is not a generally
especially since the addition of intravenous sedation monitored
anesthesia professional is both comfortable and safe. Most
advocate local anesthesia for major cosmetic procedures
facilities and hospital privileges for these procedures.
More about Cosmetic Surgery with Only Local Anesthesia »
Local anesthesia (see
when provided by a CRNA (Certified Registered Nurse Anesthetist)
or an Anesthesiologist is our preference for many procedures,
since we have had extensive and successive experience with
this anesthetic approach.
In our opinion:
- Is safer than a general anesthetic
- Minimizes post-operative recovery, as well as, nausea and vomiting
less stressful on patient
- Requires no breathing tube; therefore, no resulting sore throat
- Reduces cost by using office facility
- Twilight Sleep may be used for
GENERAL ANESTHESIA (see below »)
produces complete loss of consciousness and, therefore, the complete loss
of the perception of pain.
Anesthetic agents are administered intravenously or by inhalation (gas)
by an anesthesiologist or CRNA.
- Procedures requiring general anesthesia are done at an appropriate
facility: a surgical hospital.
- Most procedures can be carried out in our office surgical facility,
which is accredited for IV sedation or twilight sleep (AAAAFS). In fact,
our extensive experience with local anesthesia and twilight sleep allow
us to perform most of our surgery safely and effectively.
- In any surgery, the choice of anesthesia ultimately rests with the surgeon; however,
it is our belief that a well-informed patient can understand and participate
in this important decision.
MEET OUR ANESTHETIST
Forman, CRNA, has been administering anesthesia for the surgeons of
North Dallas Plastic Surgery Associates since 1996. Prior to that time
her experience focused on anesthesia for trauma and for cosmetic surgery
in New York City and Fort Worth.
Mahlon has been practicing since June of 1980
when she qualified on the national board exams and continues to be re-certified
every two years by the National Board for Recertification of Nurse Anesthetists.
She is also certified by the American Heart Association in Advanced Cardiac
Mahlon currently specializes in intravenous sedation with monitored care, which
demands not only a knowledge of the science of anesthesia, but an aptitude for
the art of anesthesia. Her philosophy stresses patient care, communication, and
Gain Without Pain!
Cosmetic Surgery: Promises and Pitfalls™
surgery can be performed painlessly by using current,
safe and effective anesthesia methods. “No pain,
no gain” may be applicable to exercise, but not to
Type of anesthesia used depends on several factors:
- Procedure - location, extent, etc.
- Surgeon - preference based on training, experience
- Patient - choice may be influenced by previous experience
of self or other
- Anesthesia provider preference
Ultimate decision by the surgeon may be made in conjunction
with patient preference. Patient comfort and safety should
be the major factors in this decision. Modern anesthesia
techniques are safe, but require:
- Qualified and competent anesthesia providers
- State-of-the-art anesthesia, resuscitation and monitoring
- Preoperative evaluation and preparation of patients
- Appropriate choice of anesthesia technique for surgical
procedure, surgeon and patient
Accredited surgical facility (See our thoughts here - .)
OVERVIEW: TYPES OF ANESTHESIA
A local anesthetic agent (Novocain,
Xylocaine, Marcaine, etc.) is introduced into the tissues
(injected). This technique provides a profound numbness
that allows selective surgical procedures to be carried
out with no discomfort in an awake patient.
Read more about Plastic Surgery with Only Local Anesthesia »: Can it be as safe and comfortable?
INTRAVENOUS SEDATION: (Twilight Sleep)
this technique, relaxing drugs are administered
into a vein. The medications are used in appropriate
doses to provide anxiety relief, amnesia for the
surgery and a light sleep.
However, patient’s normal reflexes are maintained
during the entire anesthetic period; in other words, at
all times, the patient is able to breath without assistance,
has a normal gag reflex, which is protective should unexpected
vomiting occur, etc.
- It is NOT intended to provide relief of surgical pain,
which is the purpose of the local, dilute local infiltration
or regional anesthetic that is used in conjunction with
the IV sedation.
- If IV sedation produces complete loss of consciousness,
then it is actually a general anesthetic (because this
is the definition of general anesthesia). This situation
is to be avoided.
- IV sedation is usually provided by an anesthesiologist
- Careful monitoring of the patient’s vital signs ensures
- It requires only a limited recovery period.
- It usually is associated with less nausea
and vomiting than general anesthesia.
avoids the added risk of a general anesthetic.
anesthetic technique produces complete loss of consciousness and, therefore,
complete loss of the perception of pain.
Anesthetic agents are administered intravenously or by inhalation (gas) by an
anesthesiologist or CRNA.
- A breathing tube is placed in the windpipe to maintain a clear breathing
passage (airway) and respirations are assisted by the anesthetist or anesthesiologist.
- A wide range of vital signs is monitored constantly utilizing electronic
(often computerized) monitoring equipment.
- However, any general anesthetic carries certain risk, which includes blood
clots (pulmonary emboli), post-operative breathing problems (pneumonia, etc.),
as well as, activating preexisting health problems, including heart, lung,
- A recovery period in a specially equipped recovery area is required to
ensure patient safety and varies from 30 minutes to several hours.
- Modern general anesthesia, used in a suitable setting (hospital,
surgicenter, accredited office facility, etc.) and administered by a qualified
anesthesiologist or nurse anesthetist, is very safe.
Procedures Page »
Promises and Pitfalls Information »