General Anesthesia vs Sedation
When considering facial plastic surgery, one of the most important topics to discuss is the type of anesthesia being used. General anesthesia, IV sedation, and local anesthesia are all good options depending on what type of surgery you are having. Each facial plastic surgeon has their own specific preferences of what they like to use and why. Read my blog to learn more about why I prefer the different options for each procedure.
What is General Anesthesia?
General anesthesia involves a combination of medications that put you into a controlled, reversible state of unconsciousness. It requires an endotracheal tube (ET tube), which is placed in your airway to ensure you can breathe safely throughout the surgery.
The tube has a small balloon that inflates within your airway, creating a seal that prevents anything from entering your lungs. This feature is especially important in surgeries where there’s a risk of blood or fluids being aspirated, such as:
- Rhinoplasty (nose surgery)
- Brow bone reduction (to address a prominent brow ridge)
- Facial feminization surgeries
- Procedures involving the mouth or throat, like jaw contouring, sliding genioplasty, and placement of cheek or chin implants.
Aspiration of fluid in the lungs can lead to pneumonia, so attention to detail is key for a safe recovery from surgery.
Under general anesthesia, you’re completely unaware of what’s happening and won’t feel or remember a thing. This allows me to work efficiently and safely, especially during longer or more complex procedures.
What is Sedation?
Sedation, often called “twilight anesthesia,” involves giving medication to relax you without rendering you fully unconscious. Sedation can range from mild (you feel drowsy but awake) to deep (you’re almost unconscious but can still breathe on your own). Unlike general anesthesia, sedation does not require an ET tube to secure the airway. Instead, your natural breathing reflexes remain intact, but this comes with some risks.
One of the challenges with sedation is maintaining the right balance. If you’re too awake, you might feel discomfort or move during the procedure, which can be dangerous. If you’re too deeply sedated, your breathing can become shallow, requiring interventions to support your airway. Achieving this fine balance can prolong already lengthy surgeries, making sedation less efficient for complex facial procedures.
What About Local Anesthesia?
Local anesthesia involves numbing a specific area of the face with injections. You remain fully awake but won’t feel pain in the numbed region. Local anesthesia is typically used for minor, quick procedures, such as:
- Mole removal
- Minor scar revisions
- Lip lift
- Buccal fat removal
- Upper blepharoplasty
- Facetite
- Some injectable treatments, like fat grafting or filler corrections
While local anesthesia is safe and effective for smaller procedures, it’s not practical for surgeries requiring significant tissue manipulation, such as facelifts or rhinoplasty.
Why I Prefer General Anesthesia
As a surgeon, my priority is patient safety and optimal outcomes. For complex or lengthy facial plastic surgeries, I prefer general anesthesia over sedation for several key reasons:
1. Stable Airway Protection
During procedures like rhinoplasty or brow bone reduction, there’s a higher risk of blood or other fluids entering the airway. An ET tube provides a stable airway and prevents aspiration, ensuring your safety throughout the surgery.
2. Efficiency in Surgery
General anesthesia allows me to focus entirely on the surgical procedure without worrying about managing your level of sedation. With sedation, I must constantly monitor whether you’re too awake or too deeply sedated, which can slow down the process. General anesthesia provides a controlled environment that enables me to work more efficiently.
3. Reduced Risk of Anesthesia Awareness
One of the most common fears about anesthesia is waking up during surgery. This is far more likely to occur under sedation than general anesthesia. With general anesthesia, you’re fully unconscious and monitored closely by an anesthesiologist who ensures your comfort and safety.
4. Peace of Mind for Patients
Many of my patients feel more comfortable knowing they’ll be completely asleep and unaware during their surgery. General anesthesia eliminates the worry of hearing or feeling anything during the procedure.
Addressing Common Anesthesia Concerns
1. Waking Up During Surgery
The idea of waking up mid-surgery is terrifying but extremely rare with general anesthesia. This concern is more common with sedation, as achieving the perfect balance between light and deep sedation can be challenging.
2. Safety Risks
Modern anesthesia is incredibly safe when administered by trained professionals. Fatal complications are exceedingly rare, but when they do occur, they’re often linked to procedures performed under sedation without a secure airway. The tragic death of Joan Rivers during a throat procedure highlights this risk. She was undergoing a procedure under sedation.
3. Side Effects and Recovery
Both general anesthesia and sedation come with potential side effects, such as nausea or grogginess, but these are typically short-lived. Recovery from general anesthesia may take slightly longer, but the safety benefits outweigh this drawback for complex procedures.
When Sedation May Be Appropriate
Despite my preference for general anesthesia, there are scenarios where sedation can be a good option:
- For shorter, less invasive surgeries
- For patients with specific medical conditions that make general anesthesia riskier
- When a patient strongly prefers sedation after discussing risks and benefits
Sedation is still an overall safe and effective option when performed by a skilled team in the appropriate setting. However, it’s not my preferred choice for surgeries requiring meticulous precision and a stable airway.
Choosing the Right Type of Anesthesia
Ultimately, the type of anesthesia used will depend on several factors, including the procedure, your medical history, and your personal preferences. During your consultation, we’ll discuss your goals, review your health history, and decide together what’s best for you. My top priority is always your safety, comfort, and achieving the results you desire.
If you have questions or concerns about anesthesia, don’t hesitate to ask during your consultation. I’m here to guide you through every step of the process, ensuring you feel confident and prepared for your surgery.
