Why is Local Anaesthetic Trending for Plastic Surgery Procedures?

Why local anaesthesia is trending in plastic surgery over general anaesthesia...

A version of anaesthesia is always given when there’s an incision involved - nobody is expected to be happy with feeling pain or discomfort, so general anaesthesia has long been a preferred option for these reasons.

Many surgical procedures are carried out using general anaesthetic, but in fact a large number of these can be done using only a local anaesthetic. Many surgeons around the world are beginning to reduce the use of general anaesthesia, when not absolutely necessary, for a range of reasons.

What is the difference between local and general anaesthetic?

General anaesthetic, administered either intravenously or via inhalation, affects the whole body and causes a loss of consciousness, whereas local anaesthetic is administered to create an absence of pain in a specific location of the body (without a loss of consciousness). 

Why choose local over general anaesthetic? 

General anaesthetic, as safe and effective as it is, can add a level of stress on the patient’s body as well as potential added side effects when regaining consciousness. Other reasons are that once a patient is under general anaesthetic and unconscious there is a reportedly higher risk of bleeding, bruising, swelling and recovery. If a patient has an adverse reaction to general anaesthetic, there is risk of vomiting which could potentially tear any sutures. Some surgical procedures need to use general anaesthetic and the risks are minimal, however if there is an option to use local only, then why not? 

Some patients prefer the idea of being able to stay ‘awake’ or lightly sedated during the procedure, however many feel that being able to wake up when it’s all over is the preferred, more comfortable option. 

Some of the popular procedures which only require local anaesthetic, or what is known as ‘twilight’ anaesthesia (applied intravenously, twilight anaesthesia induces sleep without the risks that general anaesthesia can carry, side effects are minimal and patients often feel rested afterwards) include facelifts, lip, chin and cheek augmentation, eyelid surgery and brow-lifts. 

A large majority of plastic surgery procedures could be done using local anaesthetic but in general it comes down to the patient’s physical situation, as well as their preference. Considering the best method for each individual is the primary concern. The main objective is that the patient is safe, comfortable and feels no pain. 

Does the cost differ with general or local anaesthesia?

Usually the complexity and materials required for general anaesthesia do raise the cost somewhat in comparison to local anaesthesia. An experienced anaesthesiologist must administer it and be present to monitor the patient’s progress. 

Which plastic surgery procedures are popular using local anaesthetic?
Upper Eyelid Blepharoplasty

This does not appeal to some people due to the proximity of the surgery being so close to the eyes. Despite this, the removal of excess skin of the eyelids is a popular procedure using local anaesthetic. The procedure is relatively quick and straightforward covering a small section of skin and the patient would have no feeling here at all,  making it a good candidate for local anaesthesia. Lower lid is not as recommended as it is a trickier procedure. 

Removal of Buccal Fat 

Buccal fat is basically excess fat in the cheeks, to remove this a small incision is made in the mouth. A numbing injection of local anaesthetic is all that is required for this procedure but some people may still prefer general as the pressure involved can be disconcerting and therefore stressful if awake. Still, this is a very popular one for the local fans and oral medicine can be taken to help the patient to relax. 

Facelift, fat grafting, browlift…

Most surgeries that involve facial skin can be achieved pain-free under a local anaesthetic. As with any of the surgeries mentioned, the patient will feel the first set of numbing injections, but feeling during the rest would be undetected. 

Liposuction

Liposuction under local anaesthetic in an isolated, small, relatively superficial area of the body, such as the upper arms and chin for example, works well. The fat in these types of zones is fairly easy to remove and the suction less aggressive than in the tummy or larger areas. The procedure works in exactly the same way whether using general or local anaesthetic so there is no compromise when it comes to the treatment. The only feeling that would be different if awake is the insertion of the anaesthetic,  and that the senses are still fully functional, so you’d be able to hear the noise of the suction and any pressure applied during the procedure. 

Lip Lift

A lip lift involves the removal of a thin strip of skin, just below the nose, to reduce the length between nose and upper lip by raising it slightly. Many surgeons actually report that it is better (for them) to carry out this procedure under local anaesthetic due to the absence of the breathing tube needed under general aneasthesia which can obstruct their view and perspective.  This is a pretty quick procedure which will not involve any pain once the area is totally numbed, and so it is a popular one for local anaesthesia. 

The Bottom Line

A large majority of plastic surgery procedures can be done using local anaesthetic but in general it comes down to the patient’s physical situation, as well as their preference. Considering the best method for each individual is the primary concern. The main objective is that the patient is safe, comfortable and feels no pain.