By: Ruth Donnelly
Created on 12th September 2011
With the recession in full swing, we’re all leading busy lives trying to keep ourselves in a job and earn the money to support our lifestyle, which often means we can’t spare the recovery time associated with a general anaesthetic.
Luckily, more and more surgeons are offering major cosmetic surgery procedures like facelifts and breast augmentation under local anaesthetic, but not everyone in the industry believes that this is such a good idea.
Here, two leading plastic surgeons offer very opposing views on the subject and give their answers
to the question: local anaesthesia surgery – do the benefits outweigh the risks?
NO – Peter Hodgkinson
"One of the worries about operations under local anaesthetic is that there isn’t another medically qualified, senior person there, whose job it is to monitor the safety of the patient. If
I’m operating and concentrating on the surgery that I’m doing, I can’t devote the attention that is needed to the patient’s safety.
In procedures around the face, one of the major advantages of general anaesthetic is that the airway is protected – it’s important for the patient to breathe and the anaesthetist takes responsibility for the safety of the airway, as well as monitoring the blood pressure and heart rate.
Another thing is duration. A facelift can
take two and a half hours – it probably should take that long if done properly – and whilst
it’s perfectly possible to keep a face numb for that long using a local anaesthetic, it is difficult for the patient to remain perfectly still on an operating table for that length of time, so often sedation is needed.
If you ask anaesthetists, they would tell you that an unfit person is actually at more risk from local anaesthesia and sedation than they would be from well-controlled general anaesthesia.
Finally, the use of local anaesthetic often trivialises cosmetic surgery. In the US there
has been an uproar about local anaesthetic procedures being performed in consulting rooms, rather than operating theatres, because it’s cheaper. That is downright dangerous, and I would hate to see that trend here."
Mr Peter Hodgkinson (www.cobalttreatmentcentre.co.uk) is a consultant plastic surgeon operating in Newcastle, with a particular interest in surgery to the face. He performs the majority of his cosmetic surgery procedures using a general anaesthetic "I use local anaesthesia for some procedures where it’s appropriate – for prominent ear correction, for example. For larger operations however, I am a firm believer in the benefits of general anaesthetic.
YES – Peter Paterson
"When I started my surgical practice, it was the rule that most cosmetic procedures were performed using general anaesthesia.
Cosmetic procedures were costly as they included the anaesthetist’s fee, the hospital bed and overnight nursing care. Patients were often reluctant to undergo surgery because of a fear of general anaesthetic complications, of which deep vein thrombosis is the most talked about.
Over the last three years I have turned my practice around and perform about 75 per cent of all my cases on an outpatient basis using local anaesthesia without sedation. Patients are given a choice and more often than not select this approach.
So why is local so popular?
Feedback from patients is that they don’t want to be put to sleep for fear of never waking up; they don’t like the ‘hangover’ effects of general anaesthesia; they don’t want the inconvenience of preoperative blood tests and heart monitoring; they don’t want to pay for the ‘added extras’ and most would rather recover at home than in a hospital room.
After 670 cosmetic procedures, 110 facelifts and 95 breast augmentations, I can say that there is a significant difference in the recovery times compared to those that I do under general anaesthetic.
Using local anaesthesia I have performed surgery on patients not deemed suitable for inpatient treatment because of pre- existing medical conditions.
Remember that general anaesthetic procedures affect the whole system and that local anaesthetics by definition only act locally.
The question is then: why isn’t local anaesthetic surgery more widely available? The answer is that most surgeons prefer their patients asleep!"
Mr Peter Paterson (www.sandonhouseclinic.co.uk) is a consultant plastic surgeon operating in Lancashire. Since opening his private clinic in 2008, he has performed in excess of 100 facelifts and 80 breast augmentations using pure local anaesthesia
