Cosmetic surgery and anesthesia

Many cosmetic surgery procedures can be performed by your plastic surgeon in the office under local anesthesia. I perform all of my facelifts, eyelid surgeries (blepharoplasty), nose tip surgeries and minor liposuction in the office under local anesthesia. Local anesthesia saves the patient the cost and risks associated with general anesthesia, or so-called “twilight sleep.”

Many other cosmetic surgery procedures, such as breast enlargements, breast lifts or breast reductions, larger liposuctions and tummy tucks (abdominoplasty) must be performed under general anesthesia or at least anesthesia that requires the placement of an intravenous line and intravenous medications. It is in these cases that you need to have an anesthesiologist or a nurse anesthetist taking care of you. Hopefully your surgeon will be too busy doing surgery and not be able to tend to your anesthesia him or herself!

 Cosmetic surgery anesthesia pros

Most surgery centers will have an anesthesiologist or two to supervise a number of nurse anesthetists who actually provide the anesthesia. During your cosmetic surgery it is not unusual to have the anesthesiologist and anesthetist change position and go in and out of the room as needs for other patients in the surgery center dictate.


Anesthesiologists are medical doctors complete a residency in anesthesia for 3 to 4 years after medical school. They then have to pass a board exam to be fully accredited and board-certified anesthesiologists. In some hospitals, these doctors take care of all the anesthesia needs of patients, but increasingly they supervise a cadre of other health professionals known as nurse anesthetists.

Nurse anesthetists, or CRNAs

These medical professionals are nurses who undergo further training for two years to become certified registered nurse anesthetists, or CRNAs. These nurses are trained to give you anesthesia and work under the supervision and responsibility of a medical doctor, either an anesthesiologist or your cosmetic plastic surgeon. They are in charge of making sure that your physiological functions are normal, monitoring the amounts of fluids you need during surgery and of course providing you with pain relief.

Many surgical centers and hospitals have turned to nurse anesthetists to provide anesthesia services at a more cos- effective rate than anesthesiologists; however, despite the push coming from the nursing lobby to have them practice without supervision, they are not doctors. Some have years of experience, but their knowledge of anatomy, pharmacology and physiology is superficial, and in an emergency situation they fulfill an ancillary position.

Plastic surgery anesthesia techniques

Cosmetic plastic surgery patients have particular needs and also need special techniques of anesthesia.

Not only is post-operative pain control important, as in any surgery, but cosmetic patients in particular need to have coughing well controlled after surgery to prevent increased blood pressure leading to bleeding or breaking of sutures such as after a tummy tuck.

Most cosmetic surgery is performed as an outpatient procedure, and having the right amount of anesthesia to allow the patient to leave the recovery room and go home is important; no one wants to stay in the hospital if they can avoid it.

Like the other members of your plastic surgery team, the anesthetist is a vitally important part without whom surgery would be… let’s say difficult. Having a team of professionals who know what your plastic surgeon needs and wishes is the recipe for success and a smooth-sailing cosmetic surgery.

Morad Tavallali, M.D., FACS

Cosmetic Plastic Surgeon