Anesthesia is an important consideration in making a decision about surgery. The main factors in selecting the type of anesthesia for a given surgery are safety and effectiveness. Anesthesia is generally very safe. but in the few instances when complications do occur in the setting of facial plastic surgery, they are usually related to general anesthesia. Fortunately, all facial surgery procedures performed in our centre are done under local anesthesia with sedation, also known as "twilight anesthesia".

Local Anesthesia With Sedation

This is Dr. Samaha's preferred method of anesthesia. It is part of an overall maximum results-minimal recovery approach he has implemented and fine-tuned over years. Dr. Samaha has been using this type of anesthesia since 2001 for all his facial plastic surgery procedures, including rejuvenation surgery. In that time, he has had no complications. Following surgery, over 99% of patients have reported that if they had to go through surgery again, they would choose this type of anesthesia over general anesthesia.

"Twilight anesthesia" in our centre involves the use of a local anesthetic to freeze the area being operated, combined with a sedative to help the patient fall into a dream state where he/she is unaware of his/her surroundings.

First, the patient receives an injection in a muscle (for example the thigh or buttock). This injection contains a pain killer and a sedative medication. As this medication gets into the patient's system, it induces a sleepy and relaxed state. Anxiety dissipates and the patient feels completely relaxed and comfortable. Further medications are then administered through an intravenous to induce a light or more profound sleep, depending on the particular needs of the patient and the operation. Once the patient is in a "twilight" state, Dr. Samaha uses a local anesthetic to numb the area to be operated, and the surgery begins.

Throughout the procedure, patients are sleeping comfortably, unaware of their surroundings. As Dr. Samaha performs the surgery, he is continuously aware of the patient's state of "sleepiness". He controls the degree of sedation or "sleepiness" by giving additional doses of medications throughout the procedure to ensure that the patient is completely unaware of their surroundings and sleeping comfortably.

This type of anesthesia benefits the patient in many ways because it avoids the "invasiveness" of a general anesthetic with its associated risks and inconveniences. Because of the decreased invasiveness of this approach, there is less swelling and bruising after surgery. The coughing, nausea, and vomiting sometimes associated with general anesthesia are avoided, and the time necessary to complete the procedure is decreased. In addition, this approach imposes less "stress" on the system. All these factors contribute to a faster recovery and quicker return to daily activities.

General Anesthesia

General anesthesia is administered by making the patient completely unconscious and paralyzed. A breathing tube in placed through the patient's throat into the trachea and an anesthesia machine breathes for the patient who is monitored throughout the procedure. When the procedure is completed, the tube is removed and the patient is awakened. This type of anesthesia is more invasive option as it places more of a "stress" on the system. There is a longer period of recovery, and more nausea and vomiting after surgery. In addition, there is usually more bruising after surgery.

Dr. Samaha favors local anesthesia, as do his patients, because it is less invasive and allows for a faster recovery. However, when it is required, general anesthesia is also an available option.

Frequently Asked Questions

Am I awake during the surgery with sedation anesthesia?
No. Patients are sleeping comfortably. The main difference is that instead of having a tube in the throat and an anesthesia machine breathing for you, you are breathing comfortably on your own.

Is sedation anesthesia used widely?
Although this type of anesthesia has been used for decades, it is becoming somewhat of a lost art. Nowadays, more surgeons in North America are tending to perform surgery under general anesthesia. The reason for this is that surgical training takes place in large teaching hospitals where the overwhelming majority of procedures are performed under general anesthesia. Surgeons are therefore trained to perform surgery exclusively under general anesthesia. Additional training and experience are required to perform surgery under local anesthesia, with or without sedation, and most surgeons do not acquire this additional experience.

Which type of anesthesia is best suited for me?
Most patients are good candidates for either type of anesthesia. Rarely, a patient may be more suited for one type of anesthesia over another. Dr. Samaha takes into consideration the patient's medical condition, his/her preference and the type of procedure planned to recommend the anesthesia that best suits the patient.

To find out more about anesthesias, please contact Dr. Samaha.