The Innovator

By: Ruth Donnelly
Created on 03rd February 2011

In this series of articles, CosmeticSurgeryToday.co.uk tells the stories of the men and women who are pushing forward the boundaries of aesthetics. In this issue the spotlight is on Mr Peter Paterson and his revolutionary practice offering cosmetic surgical procedures under local anaesthetic

Who: Mr Peter Paterson, FRCSPlast

What: LA Surgery

Why: Walk-in, walk-out cosmetic surgery under local anaesthetic

One thing that puts a lot of people off having cosmetic surgery is the fear of going under a general anaesthetic. Mr Peter Paterson, surgical director of Sandon House Clinic in Preston, offers his patients the choice of having almost any procedure performed under local anaesthetic.

Making of an innovator

Mr Peter Paterson completed a cosmetic surgery fellowship in London in 2004 and commenced work as a consultant plastic surgeon at the Royal Preston Hospital in 2005.

“In the private practice where I was working, I saw a number of patients who I felt had been overcharged by the local hospital for very minor procedures,” he says, “and that’s because they were having them performed under general anaesthetic.

“I didn’t think that was necessary, so I decided to offer a more cost-effective alternative by using the plastic surgery theatre at the NHS hospital, out of hours, to offer those same procedures under local anaesthetic.”

When demand for these procedures began to outstrip what was possible given the time constraints, it occurred to Mr Paterson that perhaps it was time to set up business on his own, where he could offer nonsurgical cosmetic treatments as well.

“Essentially, I was in the right place at the right time,” he explains. “My brother’s a builder and he had some land, so he said, ‘why don’t you build your own clinic?’

“We were granted planning permission and went through all the necessary health and safety checks to enable us to register as a hospital offering day case surgery.”

Opportunity knocks

Sandon House Clinic opened for business in 2008, with the initial plan being to perform minor surgery, such as ear correction and mole removal, in the clinic under local anaesthetic, with larger cosmetic operations being performed under general anaesthesia at a local hospital.

However, Mr Paterson had always felt it was possible to offer any surgical procedure under local anaesthetic, given the right patient. “One day, a patient came in who had multiple sclerosis,” he recalls.

“She desperately wanted a breast augmentation, but there was no way she was going to risk a general anaesthetic, so she wanted to know if it could be done under local.”

This was just the catalyst Mr Paterson needed to put his theory into practise: “We had a long discussion and I explained that I’d never done it before, but so long as she accepted that I was happy to do it.

“So we agreed to give it a go and I performed her operation using pure local anaesthetic with no sedation and it was fantastic. It took about an hour and a half and she was over the moon with the results. That was a real eye opener as to what we could do.”

Risky business

So what are the risks involved with general anaesthesia? “The main problem is sedation,” Mr Paterson explains.

“General anaesthesia usually means an overnight stay in hospital and you have to starve yourself for six hours before the procedure, and patients tend to feel woozy for several weeks after surgery.

“Then there’s the question of cost – you have to have an anaesthetist on hand if you’re sedating a patient, and you have to pay for a bed and nursing care for the duration of the hospital stay. With LA procedures, you can shave around 30 per cent of the price of surgery.”

The domino effect

There’s no better marketing material than a happy customer, and sure enough it wasn’t long before friends and acquaintances of Mr Paterson’s original LA surgery patient began queuing up to have the cosmetic procedures they’d always dreamed of, without the added stress of sedation.

“It’s been quite amazing,” Mr Paterson admits. “She told her friends and then they told theirs, and before I knew it I’d done 60 breast augments and 100 facelifts in a year, all under local anaesthetic. I’ve had patients from all over the country coming to me, because as far as I’m aware there is no one else offering this service.”

Whilst the idea of being awake during an operation may seem bizarre, Mr Paterson can list many advantages: “What’s particularly great is, when I’m doing a breast augmentation, I can involve the patient in the implant size.

“I put an implant in one breast, sit them up and ask them if that’s big enough, if they’d like to go down a size – they can make that decision knowing exactly what the final result will be.”

One of a kind

It seems strange that so few surgeons perform cosmetic procedures under local anaesthetic, when if offers so many benefits.

“I think it’s just that we’re all creatures of habit,” says Mr Paterson. “If you’re taught to perform these operations using general anaesthesia, you think that’s the only way it can be done. When I was a trainee, I saw how much can be done using regional techniques, when treating cancer patients.

“You can do a lot, it’s much safer, the recovery is quicker and there’s much less swelling and bruising than with general. So I always thought, why put yourself to sleep and take that risk, if there’s the chance that you could have that same procedure using local anaesthesia.”

One size fits all

“The main operations I perform under local anaesthetic are breast augments and facelifts,” Mr Paterson tells us, “but really you can do almost anything – I’ve done blepharoplasty, liposuction, mini-abdominoplasty, arm lifts, labial reductions...

“The only procedures I wouldn’t do would be larger ops, like full abdominoplasty or breast reduction. But in the U.S. there are people who perform even those surgeries under local.”

So if the thought of sedation or an overnight hospital stay has been putting you off making that final step towards the face or body of your dreams, perhaps it’s time to give Mr Paterson a call.However, Mr Paterson had