There is a disturbing new trend in cosmetic surgery called “awake surgery” that promoters claim can avoid the risks of general anesthesia and reduce the cost of the procedure. In awake surgery, instead of general anesthesia, patients are given an oral sedative and a local anesthetic such as lidocaine. Procedures such as breast augmentation, liposuction, and tummy tucks are being performed on patients with only this local anesthetic.
Proponents of awake surgery point to numerous benefits of awake surgery. Since the patient is not under general anesthesia, the procedure can take place in a common exam room instead of a hospital or certified surgical suite. Also, the length of the procedure will not be limited to six hours which is the generally accepted safe limit of plastic surgery under general anesthesia. Practitioners also emphasize that the patient is conscious and alert and can interact with the doctor during the procedure. They claim that it is important to have the patient’s input on certain specifics such as the size of a breast implant.
However, the reality is that the vast majority of doctors who perform awake cosmetic surgery are not board certified plastic surgeons. Instead, they are family practitioners, radiologists, and others who have taken a two or three day course in a certain procedure. They lack the years of broad based training and experience in cosmetic surgery that a board certified plastic surgeon has.
In addition to untrained doctors performing these procedures, awake surgery presents numerous risks. Lidocaine toxicity is a real concern and the reality is that these procedures should not take six or more hours to be completed by a skilled plastic surgeon so the risk of general anesthesia are greatly overstated. In addition, pain control is less effective with local anesthesia.
The real reason doctors practice awake surgery is that they can avoid using an anesthesiologist and the oversight that come with it. By using local anesthesia, a doctor can perform the procedure in the office rather than in a hospital or other accredited operating room and avoid having to comply with the strict safety standards that are required for an accredited surgical suite.