Anesthesia Awareness: Do I Have to Go Under

By Brook Flagg © 2008-2009 Staff Writer

If there is an area of your body that you’ve always hoped to improve with plastic surgery, it is probably time to take a look at your to-do list:

Start researching the procedure of interest? Check. Trying to find a plastic surgeon who has years of experience in the procedure you want? Check. Gather information regarding anesthesia? Wait a minute… Did I miss something?

Some procedures can be safely accomplished while the patient is awake with a local anesthetic.

Anesthesia, which is used to block painful sensation during surgery, is a major area of concern for many prospective patients. Additionally, while qualified surgeons are able to make solid recommendations regarding anesthesia; they also encourage patients to educate themselves on what is available. “Of course, we want them to be completely comfortable,” says Carol Hollan, M.D., F.A.C.S., a board certified Southern California plastic surgeon based in La Jolla. She, like most cosmetic and plastic surgeons, works alongside anesthesiologists to determine the best course of treatment for each patient.

Recognizing that some patients are adamant regarding their anesthesia preferences, “The ultimate decision,” Dr. Hollan says, “is between the patient and the anesthesiologist.”


Therefore, before insisting upon one particular anesthesia over another, it’s important for patients to have an understanding of what is normally administered. With that in mind, categories of anesthesia (from large to small) are: general, regional, and local, which can be utilized with conscious sedation. Although the right choice for you is best determined with your doctor’s guidance, it is helpful to inform yourself on the details of anesthesia. With the help of the following information, including the professional insight from Dr. Hollan, you can play a more active role in your surgical plan (remember to also learn about the costs of plastic surgery before making a major decision!):

General anesthesia, which offers the highest degree of sedation, is usually recommended for extensive procedures. Some procedures can be safely accomplished while the patient is awake with a local anesthetic; however, Dr. Hollan finds that general anesthesia is often a better choice. Frankly, she says, “People do their homework to see how they can avoid general, but the patient is better managed when asleep than awake.” She believes that when the patient is asleep, the risks of adverse effects are actually reduced. Additionally, the most common side effects of general anesthesia are not usually a serious threat to the patient. Typically, patients report nausea and grogginess for the first several hours after awakening. Your anesthesiologist, who is obligated to monitor you throughout the procedure, is trained to address any reactions that may occur.

AnesthesiaRegional anesthesia is a term that some patients are unfamiliar with, but that may be due to the fact that it is sometimes casually mistaken as local anesthesia. The difference between the two is that regional anesthesia is used to block sensation in a specific region (rather than a small location) of the body. One example of regional anesthesia – perhaps best familiar to childbearing women – is the epidural. Designed for the lower half of the body and administered through the spine, it can also be used in cosmetic procedures under certain conditions. Typically, it is only used for inpatient situations. The reason for this is, says Dr. Hollan is that “it can last a long time, and we can’t send them home if they can’t walk.” However, regional anesthesia for the upper body, used for procedures such as upper arm surgery (brachioplasty), may be appropriate, depending upon your physician’s preference.

Local anesthesia is used to block pain in smaller areas of the body, and is only effective on the area of treatment. For example, some doctors may use a local anesthetic for patients receiving facial injectables, such as Botox ®. As for some surgical procedures, local anesthesia is administered with other medications to place the patient in a state of conscious sedation. This offers the patient the opportunity to stay awake during the procedure, and patients who want to feel “in control” may find the concept appealing. While this might be the ideal result for many, if the patient is already nervous, staying awake is likely to lead them to heightened anxiety. Dr. Hollan often finds that when combining local anesthesia with conscious sedation “ a person can still get agitated.” When that happens, some patients request to be “converted” to general anesthesia in the middle of the procedure, which can prolong the surgery and work against the patient in the long run.

All surgical procedures are associated with some level of risk.


There are additional factors that your surgical team will consider as well. Most importantly: your personal health history. At some point prior to your surgery, you can expect to be asked questions regarding your current physical condition, medications, allergies, and habits. According to the American Association Nurse Anesthetists (AANA), some of the questions a patient should ask his or her anesthesia provider are:

Which type of anesthesia is best for me and the surgery I am having?

What should I avoid eating or drinking before I come in to have my surgery?

Which kinds of medications do you need to know I am taking before I am operated on?

I have asthma, what do I need to know before and after I have surgery?

What if I have more questions after the surgery? Who can I contact?

All surgical procedures are associated with some level of risk, so be sure to tell your surgeon about any reservations that you may have prior to surgery. Dr. Hollan uses a patient’s pre-operative appointment to address this: “I always make sure that they discuss with me any fears they have, and then I allay the fears that are not appropriate.” She believes that the risks of anesthesia, as well as the procedures themselves, are nearly equivalent to the risks we take on a daily basis – like riding in automobiles. “The most risky thing that a cosmetic surgery patient can do,” she says, “is to drive to the operating room.”


According to the AANA, “Anesthesia today is safer than it has ever been due to advances in technology and pharmacology…”

According to the AANA, “Anesthesia today is safer than it has ever been due to advances in technology and pharmacology, as well as more stringent practice standards and educational requirements for anesthesia providers.”


Together with your plastic surgeon, you have the ability to sort through the anesthetic options that are recommended for your procedure – and select the one that is right for you. Whether you are interested in saline or silicone gel breast implants, liposuction, or tummy tuck surgery, every detail involved with your procedure is important to look into.