Patients often ask whether their plastic surgery can be performed without general anesthesia. General anesthesia involves being paralyzed during surgery with medications administered by an anesthesiologist, including placement of a breathing tube and breathing anesthetic gas. Patients are concerned about the risks involved with having general anesthesia as it puts a significant amount of strain on the body. Other patients have experienced days of feeling ill with nausea, headaches and weakness after general anesthesia, and want to avoid it at all costs.
Doctor Jacono rarely uses general anesthesia in his practice when performing facial plastic surgery. Besides his natural and beautiful results, this is another reason why patients travel from all over the United States and all over the world to have surgery with him (https://www.newyorkfacialplasticsurgery.com/long-island-plastic-surgery). In fact, he prefers not to use it unless it is necessary because a patient has some other medical condition that requires it. General anesthetic drugs and gases cause major physiologic changes it the body; it causes blood vessels to dilate increasing how much you bleed during surgery. This causes bruising and swelling, which increases recovery time. Additionally, general anesthesia can induce vomiting which can lead to further trauma and torn sutures for some patients.
Face lifts, Rhinoplasties (“nose jobs”), eyelid lifts, lip augmentaton surgery, chin and cheek augmentation, and many other procedures can easily and safely be performed without general anesthesia under local anesthesia.
Doctor Jacono either performs surgery under a local anesthesia, which means the patient is wide awake and has surgery after numbing shots are administered, or under a twilight anesthesia given through an IV (no anesthesia gas is given) where the patient is asleep and not aware. In NEITHER case are they under general anesthesia.
Face lifts, Rhinoplasties (“nose jobs”), eyelid lifts, lip augmentaton surgery, chin and cheek augmentation, and many other procedures can easily and safely be performed under local anesthesia. This means being given a minor sedative like valium in a pill form to relax you, and then your plastic surgeon injects Novocaine-like local shots (similar to the ones you would get at the dentist) to numb the part of the face having surgery. Doctor Jacono uses drugs called Lidocaine and Marcaine because they last longer and are more effective than novocaine. The shots can be painful and multiple shots need to be administered, but he uses a tiny needle that spreads the medicine slowly to minimize discomfort. Because of this discomfort he does not suggest this procedure for those who are afraid of needles or have a very low pain threshold. The value in local anesthesia is that it decreases the amount of bleeding during surgery when compared to general anesthesia, and therefore bruising and post operative recovery is lessened. Also, there are additional cost savings because you do not have to pay for an anesthesiologist to administer anesthesia as the surgeon gives the shots to numb the face.
Doctor Jacono also employ music therapy prior to injections and during the local anesthesia surgery. It has been shown that playing relaxing music that a patient prefers helps lower patient's blood pressure during surgery. This limits bleeding, and therefore minimizes bruising.
For patients who do not want to be awake and aware during surgery, we perform a twilight anesthesia. This is the same anesthesia given iv (Intravenous) during a colonoscopy called propofol. This medication is like an intravenous valium, but as soon as the medicine is turned off, you wake up in a few minutes, without any nausea headache or hangover from general anesthesia gas. Twilight anesthesia also reduces bruising compared to general anesthesia. It is extremely safe, and patients often feel great after surgery just like they had a great night sleep. Any person who has had a colonoscopy (and I am one of them) can attest to this fact.
One way we modify a twilight type of anesthesia is in rhinoplasty cases. Here we place a dam in the back of the throat called an LMA that prevents blood from dripping into the windpipe. Because you are sleeping you cannot protect your airway which can become blocked with a blood clot.
Many plastic surgeons will only perform surgery under general anesthesia. While I do agree that the risks of having serious complications after anesthesia are extremely low (less than .001%), there is no question that the rate of nausea, discomfort and the increased bruising associated with general warrant these surgeons reconsider their approach. In my opinion, the reason why surgeons continue to do surgery exclusively under general anesthesia has more to do with the doctor’s comfort in performing surgery with the patient in this state, than it being the best option for the patient.