A recent article in the New York Times delves into a modern cosmetic surgery technique that is somewhat controversial, and at times dangerous. The latest trend in cosmetic surgery allows patients to be awake, though highly sedated, during their procedure. In some cases, doctors will even prop patients up to approve the size of the breast implants mid-surgery.
The article discusses how select doctors throughout the country are opting to use local anesthesia in conjunction with sedation as opposed to general anesthesia or deep IV sedation. These types of procedures are often marketed as safer and less invasive alternative to traditional plastic surgery methods; however, there are definite hazards involved.
At my fully accredited surgery cosmetic surgery suite in Naples, I perform breast augmentation and other plastic surgeries under a deep IV sedation which is safe for the patient and results in very little nausea or vomiting. Our anesthetist monitors the patient and the airway to ensure that there are no complications during surgery. Doctors will often perform procedures with local anesthesia and sedation as a way to circumvent the necessity for accreditation.
While the procedure is just as invasive either way, performing the surgery in a non-accredited office operating suite opens up a can of worms for more potential health risks. If the OR is not accredited, it may not live up to the rigorous health and safety standards set forth by the American Association for Accreditation of Ambulatory Surgery Facilities (AAASF). The necessary emergency equipment and medications may not be in place. Also, a non-accredited operating room may expose patients to a higher level of pathogens and increase their risk of post-operative infections.
Another issue at hand is that the physicians who are performing these “awake” procedures are often not certified by the American Board of Plastic Surgery. While board-certified plastic surgeons are required to have a minimum of six years surgical training, ob/gyns and family medicine doctors can take a two-day seminar and start operating immediately. Their limited training leaves the patient at greater risk of having complications, and in-turn a substandard response by the doctor if any problems are indeed encountered.
During “awake” surgeries, some doctors allow their patients to see the implants and change the size if desired. The size of the implant should be chosen by the patient prior to the surgery, not while they are incoherent and groggy. The patient can not make a conscious decision in this state, and this can result in overaugmentation and an unattractive result.
During “awake’ breast augmentation, doctors offer patients sedation and then pump in a numbing fluid that is commonly used during liposuction. The fluid includes lidocaine, an anesthetic, and epinephrine, which controls bleeding. Though rare, lidocaine intoxication is a known side effect of liposuction. Just last year, a Weston, FL, woman died after undergoing liposuction at a medspa and suffering a fatal reaction to the lidocaine used. Some doctors administer high levels of pain and anti-anxiety medicine to the patients as a trade-off for not putting them under.
While the concept of less-invasive plastic surgery is certainly desirable, it is not very realistic. When choosing your plastic surgeon and procedure methods, it is important to opt the safest option available.
To Your Health, Beauty, and Safety,
Dr. Kent Hasen
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