Ask Dr. Pane! Waking Up from Plastic Surgery what is it like?

When it comes to a cosmetic surgery procedure, plastic surgery patients universally have two questions: What should I expect from the effects of anesthesia in plastic surgery, and do I need to worry about feeling pain or waking up during surgery? These are perfectly reasonable, valid questions. Patients who don’t flinch at the idea of “going under the knife” get understandably nervous when they’re about to undergo general anesthesia, and they want to know as much as possible about what to expect from their cosmetic surgeon and care team. One example is the focus of this week’s Ask Dr. Pane segment, which comes to us from a recent Instagram Live webcast with the doctor. The patient asks, “I’m scheduled for breast augmentation next month. What’s the process of waking up from surgery? Will you be there, or will a nurse wake me up?” This is a great question, but it’s also a big one with some nuances which need to be considered. Let’s start by breaking down the various anesthesia options for an aesthetic plastic surgery procedure.

When people think of anesthesia, they generally think of medically induced unconsciousness. This is not always the best anesthesia technique for every person or purpose, and anesthesia has advanced to the point where in many cases general, or really any anesthesia, is not the right way to go for optimal patient safety. In fact, some plastic and reconstructive surgery procedures and facial rejuvenation options, such as some skin treatment methods, Botox cosmetic injections or dermal fillers, do not require anesthesia at all.

In general, there are three types of anesthesia techniques. It should be noted that there is always a risk of anesthesia reaction with the patient, ranging from very mild to (very rarely) fatal. A comprehensive medical history can help your surgery center staff and cosmetic surgeon determine the right anesthesia protocol for you and your situation, so it’s very important to be honest on your patient forms and make sure you include all your medications and allergies, to help avoid a potentially life-threatening reaction.

Local anesthesia is for awake plastic surgery. This may be administered for laser hair removal, tattoo removal, hair restoration or hair transplantation. Under local anesthetics, patients report common feelings like tugging, pulling or mild pinching sensations and maybe a little bit of discomfort, but they very rarely report actual “pick a number” pain during or after the procedure. The patient remains wide awake, conscious, lucid and capable of talking and communicating with their plastic surgeon throughout the procedure.

Conscious sedation, “twilight sedation” or regional anesthesia is the next step up from local anesthesia. This usually consists of medications called nerve blocks which are injected directed into a nerve cluster, or ganglion, to block sensation in the area, but may also involve other drugs in addition to or in place of the nerve block, depending on what the anesthesia provider believes will have the best final result and patient safety. This is commonly used in “tickle” lipo and small-area scar revision or surgical fat transfer, among other relatively minor procedures like laser skin resurfacing, if the patient requests it.

Major surgeries are the kind that requires general anesthesia. These involve extensive cutting, skin excision and a long period in the operating room, such as body sculpting like a mommy makeover, breast implant revision, nose surgery and tummy tuck, just to name a few. Most patients are given preanesthetic medication to help relax the nose and throat nerves, which helps to suppress nausea and vomiting which could occur under or after surgery. At the surgery center, their vital signs are taken and consistently monitored until they get dressed to leave. Intravenous sedation, also commonly called IV sedation, is usually administered, although gas sedation may also be used. This is where you get the “Count backwards from 100” trope many patients think of when they think of sedation. The goal of general anesthesia is to keep the patient still, quiet and comfortable during surgery and mitigate pain and discomfort feelings after cosmetic surgery. The obvious drawback is that recovery time after general anesthesia is usually longer and the patient absolutely cannot and must not drive or operate heavy machinery afterward, so they’ll either need a friend or family member to drive or to call a rideshare or taxi service.

Dr. Pane says about general anesthesia: “I will be there, though you won’t remember it. When anesthesia meets you they go over your history, put in an IV and start giving you the medicine. From that time, you won’t remember the events. You’ll wake up, we’ll check you over and you’ll go to recovery, but you won’t remember that. It’s medically imposed amnesia, basically.”

When you come to Atlantic Coast Aesthetics, you will receive the best possible care and attention to your cosmetic surgery needs and goals. Our founder and Chief Medical Officer, Dr. Thomas A. Pane, is board certified by the American Society of Plastic Surgeons and is also board certified in emergency trauma surgery. In addition to the procedures we’ve mentioned previously in this article, ACA and Dr. Pane are proud to offer the following services:

• arm lift
• body contour
• breast enhancement
• breast implant removal
• breast implants
• breast lift
• breast reconstruction
• breast reduction
• breast surgery
• brow lift
• chin augmentation
• double chin
• earlobe repair
• eyelid surgery
• feminine rejuvenation
• male breast reduction
• neck lift
• thigh lift
• and more!

If you have a question, concern or interest in any area of cosmetic surgery, Dr. Pane and the staff of ACA welcome the opportunity to discuss your questions with you. Simply click here to contact us; follow us on Twitter, Instagram, Facebook and LinkedIn; or call us at (561) 513-4763. Your question might even help us to inform and educate others as the topic of an upcoming Ask Dr. Pane segment. Remember, at ACA, we believe the only bad question is the one you DON’T ask!