Plastic Surgeon and the Anesthetist

How do I chose local, regional, sedation or general?

General generally means endotracheal tubes

Essentially there are three types of anesthesia:

1. Local anesthesia-the type a dentist gives you while you’re totally awake

2. IV sedation or “twilight sleep“. A sedative is administered intravenously to induce a deep state of sedation. 

3. General anesthesia-Sedative agents are administered both intravenously as well as through endotracheal breathing tube into the lungs.

Though the most consider IV anesthesia as being safer, ironically it can be more dangerous. Unlike general anesthesia, IV sedation does not use a breathing tube to prevent a patient’s airway from closing if sedation gets too deep. Actually, this can happen many times during an operation and that is why the anesthesia provider must stay hypervigilant to deliver enough sedation to maintain a patient’s unconscious state but not enough to stop them breathing on their own.

There are two types of patients when it comes to anesthesia-those who are very wary of any anesthesia, let alone general and those who want full general anesthesia without hesitation. Obviously, the choice as to what type of anesthesia is used during plastic surgery is a collaboration between the patient and the surgeon. 

As a Beverly Hills plastic surgeon, creating human artwork involves deep concentration, precise technique, a painstaking attention to detail and unlimited patience. Therefore I want my patient to be perfectly still, comfortable and safe so I can do my very best without being distracted,  even if the surgery is only “skin deep”. This is why I, as a facelift expert in Beverly Hills, perform my facelifts and detailed hyperaesthetic facial surgery under general anesthesia. I feel I can deliver the best results I can while the patient is comfortable and safe.

I utilize general anesthesia for most of my high-definition body-sculpting, abdominoplasties and breast enhancements to enable me to go that “extra mile”. It’s all too often I hear patients complain about their underwhelming results from surgery performed under IV twilight sleep. This is because surgeons are constrained in what they can fully achieve by a moving, uncomfortable patient. In Beverly Hills, standards are high and patients expect the best and this is why they come to my clinic from across the world for their results and not for the type of anesthesia they receive.

However, there are many situations in which I feel IV sedation is better for the patient. Those requiring modest amounts of work where pain control can be easily supplemented by injected local anesthesia are best served with twilight sleep. Generally, shorter surgeries of the skin and subcutaneous tissue but above muscle fall into this category.

endotracheal tube passing through the vocal cords
An image of the endotracheal tube passing through a patient’s vocal cords

In the end, it all boils down to the concerns and expectations of the patient and how best the surgeon is able to fulfill them. However, most honest surgeons, whether in Beverly Hills or anywhere else for that matter, would agree that their most detailed and precise work was performed under general anesthesia

Now that you had surgery, drains are your new BFF?

At the risk of sounding like I’m standing on a soapbox, I shall repeat my mantra once again . . . how well you follow up with your post-op aftercare instructions is nearly as important as what we do in the OR. Following these protocols conscientiously can ensure a positive outcome just as ignoring them can sabotage your final results.

Remember, the doctor and the patients are a team.

This is particularly true of drains. When you wake up from surgeries involving deep incisions and dissections involving an appreciable amount of surface area such as of abdominoplasties (tummy Tucks), facelifts and browlifts you’ll likely have one, two or sometimes even three tubes coming out of small incisions, each attached a suction bulb drain. They’re unsightly, true. They’re inconvenient, yes. They can be messy, absolutely. But for the duration – and this can be anywhere from 1 to ten days – that you’ll be living with them, your drains are your new body’s BFF or at least very trusted ally!

Let’s back up a minute. When surgery is performed, it is a fact that the innumerable microscopic blood vessels and lymphatic channels are cut. As a result they leak fluid in the postoperative period. Consequently, any space that was surgically created (for example, between skin and deeper muscle layer) can fill up with this fluid as opposed to getting rapidly absorbed by the body. Drains are placed within this surgically created space in order to rapidly evacuate the fluid as it is produced. The fluid in your drain, which will diminish over time, is comprised of a physiological mixture of blood and serum. As you empty the drain twice a day, recording the amount of fluid tell us the rate of decreasing fluid production and how your body is healing.

The advantages of sporting your drains for the prescribed time cannot be underestimated. Removing drains too quickly can result in untoward fluid accumulation in a surgical space potentially necessitating uncomfortable intervention afterwards to remove it. Leaving drains in the body for the appropriate amount of time will actually decrease your healing time by minimizing fluid buildup and prolonged swelling by fostering rapid adherence of the various layers to close the surgical space.

Drain connected to a self suction "grenade" style collection chamber
Drain connected to a self suction “grenade” style collection chamber
So please keep these in mind during the initial phase of your recovery if you find yourself getting annoyed. Soon enough, you’ll be in the office and we’ll remove them. Meanwhile, if you can view your drains in a positive light rather than as an unpleasant burden, it’ll make all the difference in the world.