“Nipped, tucked and wide awake, ”a recent women’s health article on msnbc.com is getting a fair amount of attention because it explores an issue in cosmetic surgery that could become an alarming trend.
“Awake cosmetic surgery” is marketed under the guise of lower cost or lower anesthesia risk. But the acutal cost may be much higher than patients realize.
To obtain a clear understanding of the issue, we asked Dr. Sugene Kim to answer a few questions that relate to the issue.
When is the right time for local anesthesia, i.e. an awake operation?
Cases done under strictly local anesthesia should be small, simple operations such as excision (removal) of lumps. In addition, patients have to be healthy and be cooperative and not nervous about being awake through his/her surgery. We always think of patient’s comfort level psychologically, and emotionally as well. Some people are okay being away and in fact want to watch their simple surgery.
More extensive surgery should be performed under IV sedation with local or under general anesthesia. IV sedation and general anesthesia should be performed by a certified anesthesiologist – not by surgeons who are also operating on the patients.
Surgeons should be focused on their surgery only, while the anesthesiologist should keep patients calm or asleep. For a long surgery, which requires airway protection or patients who are not ASA 1, patients should undergo general anesthesia. In addition, patients who are normally anxious or afraid of surgery should undergo general anesthesia.
Are procedures like breast augmentation and liposuction being performed under local anesthesia in the Woodlands or the Houston area?
I normally do breast augmentation under general anesthesia. I do not think any of my colleagues in Texas would perform breast augmentation and liposuction under local anesthesia alone. I know that some surgeons will operate under IV sedation with local anesthesia, performed by anesthesiologist. Usually, breast augmentation is done under the muscle (pectoralis major muscle); unless one has a great anesthesiologist well versed in IV sedation, augmentation may be challenging under IV sedation.