Anesthesia Options for Facial Plastic Surgery
Many people feel anxious when they hear the word anesthesia. While there are risks associated with the various types of anesthesia, knowing what to expect should help reduce any concerns you may have.
Anesthesia works in several ways. It's an analgesic (pain reliever), an amnesiac (so you don't remember the surgery) and an immobilizer (so you don't move while your surgeon is operating). Anesthesia can also promote unconsciousness and eliminate or reduce rapid heartbeat, rapid breathing, and a rise in blood pressure.
Exactly how long the effects of anesthesia last is based on many factors, including your weight, your percentage of body fat, and the type and strength of the chosen anesthetic. Your innate ability to tolerate anesthesia also plays a role in how you react. These nuances are best managed by anesthesiologists, certified registered nurse-anesthetists (CRNA) and, in some cases, the surgeon. A pediatric anesthesiologist may be best qualified for surgeries involving children, such as otoplasty (ear surgery).
Below we break down the common types of anesthesia used for facial rejuvenation techniques, along with the risks. The four main categories of anesthesia are:
- Local anesthesia
- Regional anesthesia (nerve blocks)
- Conscious sedation
- General anesthesia
Local anesthetics numb the immediate treatment area. You may have had a local anesthetic at the dentist's office to have a cavity filled. You may also receive local anesthetics in conjunction with sedation during a rhinoplasty or other type of facial plastic surgery. The injection is most commonly a combination of lidocaine (an analgesic) and epinephrine (a vasoconstrictor that impedes bleeding).
Topical agents such as EMLA (ectatic mixture of local anesthetics) cream can also serve as local anesthetics during some facial procedures such as chemical peel or laser tattoo removal. The cream must be applied an hour before the procedure for maximum benefits.
Complications associated with local anesthesia are relatively rare. There is a risk that the medications will be absorbed by your body and cause a serious systemic reaction.
Regional anesthesia or nerve blocks can anesthetize a larger area of the body than local anesthetics. Classic examples are the spinal and epidural anesthesia used for childbirth. Some facial plastic surgeries such as brow lift, lip reduction, lip augmentation or facial liposuction may require regional anesthesia.
The risks of regional anesthesia may include:
- Nerve damage (resulting in persistent numbness, weakness or pain)
- Systemic toxicity
- Heart or lung problems
- Bruising at the injection site.
Conscious sedation is often referred to as twilight sedation. It makes you feel relaxed and drowsy, sort of like you have had a few drinks. The medications used often include muscle relaxants, pain medications, and drugs that cause temporary amnesia. They can be administered by IV, inhaled gas or as a pill. Sometimes an oral sedative is given ahead of time. This type of sedation is often combined with a local anesthetic.
There are three levels of conscious sedation, including minimal sedation (you are relaxed, but awake), moderate sedation (you sleep through most of the surgery, but can be easily roused) and deep sedation (you will sleep through the entire procedure, but you can be aroused with stimulation, unlike with general anesthesia).
- Nausea and vomiting
- Unpleasant memories of your surgery
General anesthesia is used for invasive surgical procedures such as some facelifts. It affects your entire body and is usually given as liquids via IV, inhaled gases or both. About one in 250,000 people die from complications of general anesthesia, and these risks are greater for those people with serious medical conditions.
General anesthesia risks may include:
- Aspiration (when an object or liquid is inhaled into the respiratory tract)
- Breathing problems
- Allergic reaction
- Increased blood pressure
- Elevated heart rate
- Damage to teeth and lips
- Swelling in the larynx
- Sore throat, hoarseness
- Heart attack or stroke (rare)
- Nausea and vomiting
- Malignant hyperthermia (a life-threatening reaction to anesthesia)
- Systemic toxicity (rare)
Your surgeon will tell you when to stop eating or drinking before your facial rejuvenation procedure. You are instructed to fast before anesthesia to ensure there is no undigested food in your stomach. Eating or drinking can increase your risk of vomiting, which is extremely dangerous when you are in the operating room. Follow your surgeon's instructions carefully. If you must take medication the morning of surgery, do so with only a few sips of water and your surgeon's approval. Make sure to mention if you or anyone in your family has had issues with anesthesia in the past. It is also crucial to disclose information about your medical history and any medications and supplements you take on a regular basis; the latter may interact dangerously with anesthesia.
You will be monitored carefully after your surgery to detect and treat any adverse side effects from the anesthesia. Your vital signs should be checked at regular intervals, and a pulse oximeter should be used to monitor oxygen levels in the blood. You may feel nauseated, emotional or cold as you recover. These feelings are all normal and should abate as the effects of the anesthesia wear off.
Marcia V. Ormsby, MD
Annapolis Aesthetic Surgery, Inc.
116 Defense Hwy.,
Annapolis, MD 21401
10807 Falls Road, #100
Baltimore, MD 21093
Yael Halaas, MD, FACS
60 East 56th Street
New York, NY 10022