Expert: Ronald Levy, M.D. - 4/23/2011

Question
I want to have a face lift, eyelid lift, and some facial fat transfers but after consulting several plastic surgeons I am getting conflicting information about what type of anesthesia would be best to use for these procedures.  One plastic surgeon said he recommended using no anesthesia but only numbing agents so I would be fully conscious but would feel no pain...similar to Novocain in dental procedures.  When I mentioned I had an anxiety disorder and would be more comfortable with the thought of  twilight sleep (such as when I've had a colonoscopy), he said that if any anesthesia is used, it would be safer to be all the way under with a general since twilight sleep is harder to maintain and often causes breathing problems as well as irregular heart rhythms.  I've always been under the impression that the lightest form of anesthesia used would be the safest.  Could you please comment on this or give me a recommendation on what form of anesthesia would be safest for facial plastic surgery on an anxious patient?  Thank you.

Answer
Part of the answer depends on where the procedure is being done. If it is in the office, then the anesthesia is likely administered by him or a nurse and in those cases, they want to avoid heavy sedation because it is more difficult for them to control. In general, you are correct that the less anesthesia the better. In the case of twilite sleep (or heavy sedation), it is actually more difficult for the anesthesiologist to maintain you at that level while making sure you are still breathing, etc. As an anesthesiologist, that is my job and that is what you pay me for. A nurse or a plastic surgeon has other primary responsibilities so they would prefer you being asleep because it is easier for them to do.

As for the real world, assuming you are otherwise healthy, any of these methods is perfectly safe with a VERY low risk of morbidity. So ask your anesthesiologist what you want and let them advise you.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston