Risks of General Anesthesia for Cosmetic Surgery
The ISAPS numbers for 2013 were released last month, with more than 1.6 million liposuction procedures done worldwide. With the rapid rise of cosmetic surgery, both in the US and abroad, there has been a lot of press about the risks associated with cosmetic surgery. No matter how badly you think you “need it,” cosmetic surgery is always elective. As such, the risks should be reduced as much as possible. The most common “risk” of cosmetic surgery is an outcome that wasn’t exactly what the patient had in mind. This is generally the result of a lack of communication between the patient and the physician.
One area where there is significant room for improvement in the world of cosmetic surgery is in the number of procedures that are done under general anesthesia. Some procedures cannot be done while the patient is awake (such as a full tummy tuck), but many (possibly most) cosmetic surgeries can be done under local or tumescent anesthesia. There are a number of reasons to choose local over general anesthesia, but in this blog I wanted to concentrate on the risks that you can eliminate by not having general anesthesia. The large majority of serious complications of anesthesia are actually due to human error rather than the medications themselves. While general anesthesia is safe for the most part, it is not without risk.
Longer recovery.
General anesthesia has been linked to a longer post op recovery when compared to local anesthesia1-3. This applies to various types of surgery, not just cosmetic surgery.
Vital Sign Fluctuations.
Many medications used for general anesthesia can cause changes in your blood pressure (either up or down) and pulse rate, which can be dangerous to your overall health. This can lead to secondary complications such as stroke if not controlled.
More Expense.
Because of the possibility of the above changes in vital signs, general anesthesia must be administered and monitored by an anesthesiologist. There will generally be a fee for the second physician and likely for the level of monitoring that is required as well.
Side Effects.
General anesthesia has a much higher incidence of side effects that are related to the medications. These can include nausea/vomiting, headache, shivering, prolonged confusion and urinary retention. There can also be problems related to keeping your breathing passages open during the surgery, such as sore throat, pneumonia and injury to your teeth.
Malignant Hyperthermia.
MH is a rare but very serious complication that can be associated with general anesthesia. This manifests as a rapid rise in temperature and abnormalities in your electrolyte balance.
Increased risk of injury to internal organs.
This is one of the most compelling reasons to move away from general anesthesia for cosmetic surgery. When the patient is unresponsive to deep or severe pain, the surgeon is much more likely to perforate the abdominal cavity or the chest wall. This can lead to further surgeries or procedures to repair damaged intestines or to reinflate collapsed lungs.
Increased risk of fluid overload or excessive liposuction.
While liposuction done under local anesthesia is limited by the amount of tumescence (fluid and numbing medicine) you can give, there is no such limit when general anesthesia is used. As more areas are treated at one time there is an increase in the risk of fluid overload, which can damage your lungs, heart or kidneys. Longer surgery times also increase your risks of blood clots, excessive bleeding and infection.
Cosmetic surgery can be an amazing, life changing experience. However it will always remain an elective procedure and it should never be considered to be without risk. As providers, it is our duty to do our best by you, our patients, and offer you the procedures that you desire at the lowest possible risk. Be sure to discuss anesthesia options with any provider that you choose for your cosmetic surgery and be aware of the risks and benefits of each option.
Jennifer Tighe de Soto, MD is a cosmetic surgeon who is board certified through the American Academy of Aesthetic Medicine. For more advice from Dr. de Soto on body sculpting and other aesthetic treatments please visit www.omahaliposuction.com where you can read her blog and see before and after photos of actual patients.
