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[Pain and discomfort](https://aedit.com/aedition/how-much-plastic-surgery-really-hurts) are some of the most common concerns people have when considering having an aesthetic procedure. And, when opioids are out of the question – whether it’s because of allergies, a history of addiction, or simply personal preference – the prospect of invasive surgery or treatment can feel even more daunting. The good news is that there are several options for [non-opioid anesthesia and pain relief](https://academic.oup.com/asj/article/38/10/1139/4883548). These alternatives mean cosmetic surgery can be accessible to people for whom opioid-based treatments aren’t a possibility. 

We already started to explore the [future of opioid use in aesthetic medicine](https://aedit.com/aedition/opioid-crisis-plastic-surgery-recovery-pain-management), and now it’s time to continue the deep dive. We’re exploring what opioid-free surgery and recovery looks like, what other options exist for sedation and pain relief, and how these alternatives may affect your levels of comfort during and after a procedure. Plus, two patients who have undergone treatments using opioid-free medications share their experiences in an effort to reassure others in a similar situation.

## **What Are Opioids?**
Opioids refer to a class of drugs found naturally in the opium poppy plant or synthetic compounds. They are most often used in medicine to relieve pain (including via anesthesia) by interacting with opioid receptors in your brain. This is why they commonly are prescribed to treat discomfort after surgery. 

When used safely and in moderation, opioid medications can be a helpful resource to maintain comfort levels after surgery. However, at higher doses, they can cause drowsiness and even slow down breathing or heart rate. Some people feel a sense of relief or even joy after taking opioids, which makes the drug susceptible to becoming addictive.

For those who have overcome opioid addiction or who are allergic to the category, finding alternative pain relief is vital. Being [upfront and honest](https://aedit.com/aedition/questions-to-ask-your-doctor-during-plastic-surgery-consultation) with your plastic surgeon and anesthesiologist will allow them to create a plan that will be safe and effective for your needs. In the case of prior addiction, it may also be worthwhile to discuss your thoughts about having surgery with a counselor or therapist, who will be able to help you decide if you’re at the right stage of recovery to undergo a procedure.

## **What Options Exist for Opioid-Free Anesthesia?**
If you need to have opioid-free surgery, you will need to discuss this with your surgical team early on in the consultation process. Many cosmetic procedures can be performed using [anesthesia](https://aedit.com/aedition/everything-you-need-to-know-about-anesthesia) that is suitable for people who cannot use opioids. These include breast surgery ([reduction](https://aedit.com/procedure/breast-reduction) and [augmentation](https://aedit.com/procedure/breast-augmentation-with-implants)), [liposuction](https://aedit.com/procedure/tumescent-liposuction), [tummy tucks](https://aedit.com/procedure/abdominoplasty), [facelifts](https://aedit.com/procedure/awake-facelift), and more. In essence, the need to avoid opioids does not necessarily limit the types of procedures you can access.  

One of the ways surgical teams can operate without using products that contain opioids is by using a method known as [total intravenous anesthesia (TIVA)](https://pubmed.ncbi.nlm.nih.gov/23335648/). TIVA is an anesthetic that generally allows people to go home on the same day as their surgery with minimal discomfort. Unlike more common forms of anesthesia that can combine the use of gaseous anesthetics delivered via vaporizers and intravenous drugs, TIVA only uses intravenous drugs. When you are sedated for the procedure, your anesthesiologist will place an IV, usually in your arm, and you will start to feel sleepy shortly thereafter.

## **How Can You Manage Post-Op Pain Without Opioids?** 
Postoperatively, there are several [opioid-free pain relief methods](https://pubmed.ncbi.nlm.nih.gov/31568318/) that can help you remain comfortable during the first few days after surgery when pain is most common. One of the most widely used products is a long-acting local anesthetic called [Exparel®](https://www.exparel.com/). It acts over several days to numb the area operated on to help lessen your need for further pain relief medication. Exparel®, or bupivacaine, isn’t a narcotic or an opioid, so it is generally seen as a good option for patients with specific medication-related concerns.

Regardless of how you will be managing your pain post-op, your surgical team will provide you with a plan to stick to when you return home. It will include details of medications you can safely take, the timing, and the dosage. Following this plan is the best way to achieve as [smooth and comfortable a recovery](https://aedit.com/aedition/best-plastic-surgery-recovery-nurses-centers-products) as possible. If, for any reason, your pain levels don’t decrease as planned or are getting worse, it’s always a good idea to get in touch with your surgeon or their team to ensure everything is healing as planned. 

## **How Do Non-Opioid Alternatives Affect Recovery?**
Researchers have [found](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6081200/) that post-op pain levels may be slightly higher for patients who receive TIVA. However, these can be mitigated by the use of Exparel® or similar products. With any surgery, there is a likelihood that you will feel uncomfortable, especially in the first couple of days. After that time, your pain levels should subside as the body heals. Even for patients who are prescribed opioids for pain relief, it is typically only for that initial downtime period. After that, most switch over to over-the-counter remedies. We’ve said it before and we’ll say it again, following your surgeon’s suggested recovery plan to a T and proactively flagging anything that seems abnormal is the key to a safe and successful recovery.

## **Patient Perspective**
Sharing details of a past addiction with a healthcare provider can feel overwhelming, so we’ve spoken to two patients who have done just that. Here, they candidly open up about their experience having cosmetic procedures after recovering from opioid addiction and how they managed their pain during recovery.

### **JP, 38, Palm Springs, CA**
*JP recovered from an addiction several years before considering liposuction. After discussing the procedure with a friend who had gone through similar difficulties, he decided to go over the idea with his therapist before making appointments with surgeons.*

<Dialogue>
  <Question party={The AEDITION}>
    How did you approach sharing your past addiction with your surgeon?
  </Question>
  <Response party={JP}>
    This was something I was very nervous about, despite knowing that it’s a topic they likely see come up frequently. I prepared for my consultations by making a list with my therapist, so I could be sure to cover everything without feeling overly uncomfortable. It’s an awkward topic for me anyway, but we worked to make sure it would go as smoothly as it could. Then, when I booked the appointments, I let them know in my first email that having an opioid-free procedure was vital and that I was anxious about discussing it. The surgeon I ended up working with actually helped me get the subject out of the way right off the bat, so we had ‘the talk’ and then spoke about the procedure. He made me feel at ease and explained the alternative options available to me.
  </Response>
  <Question party={The AEDITION}>
    How did your recovery go?
  </Question>
  <Response party={JP}>
    I had read many articles about what to expect after my procedure, so I had in mind what to expect. I can’t say that my recovery seemed different from that of any of the people whose experiences I had read about. I was convinced I would be in a lot of pain – not because of any evidence-based research, I just had this preconceived idea – but the whole experience went very smoothly.
  </Response>
  <Question party={The AEDITION}>
    Do you have any advice for people who have overcome addiction considering a cosmetic procedure?
  </Question>
  <Response party={JP}>
    The main factor is going into it at the right point in your recovery. If I had gone into that setting a few years earlier, I think the outcome could have been different. I’m grateful I gave myself time. I would also recommend trying to set the feeling of shame aside and focusing on advocating for your needs. Surgeons and anesthesiologists are there to help their patients, and it’s ok to ask for your needs to be met.
  </Response>
</Dialogue>

### **Alice, 54, New York, NY**
*Alice had wanted to have a breast lift for as long as she could remember. After discussing her concerns with a friend who happened to be a doctor, she found she may be able to have the procedure without opioids.*

<Dialogue>
  <Question party={The AEDITION}>
    How did you came to learn about opioid-free surgical options?
  </Question>
  <Response party={Alice}>
    I have a good friend whose husband is a doctor. We were talking about celebrities having cosmetic surgery, and I happened to drop into the conversation that I wouldn’t be able to have anything done even if I wanted to because of my past troubles with addiction. He half-jokingly told me that there are plenty of alternative medications that could be used. I didn’t discuss it much more with them, but the idea stuck with me. I did my research before finding a surgeon who used these methods in their practice.
  </Response>
  <Question party={The AEDITION}>
    How were your comfort levels during recovery?
  </Question>
  <Response party={Alice}>
    I was told to expect to be uncomfortable for the first three days after my procedure, and, indeed, it was not great. However, I was able to take the medication the doctor prescribed to me, and it took the edge off the pain. I was able to sleep and get the rest I needed to heal well. After around four or five days, I started to see improvements. I felt less like I was simply waiting between two doses of painkillers.
  </Response>
  <Question party={The AEDITION}>
    Do you have any advice for people considering surgery with TIVA?
  </Question>
  <Response party={Alice}>
    Doing your own research and finding a sympathetic surgeon would be the two key takeaways for me. I found it helpful to go into a consultation with a clear idea of what I would like to hear from the surgeon in terms of their suggestions for alternative pain relief and anesthesia and their experience in dealing with patients who had similar factors to consider. Finding the right team to surround yourself with makes the process more straightforward. It is vital to tell loved ones about your plans and ask for their support. It certainly was in my case.
  </Response>
</Dialogue>

## **The Takeaway**
It is increasingly common for cosmetic surgery patients to seek out opioid-free procedures and recovery for a variety of reasons. There are also an ever-increasing number of pain management options for such patients. Honestly sharing your medical history and preferences with prospective surgeons from the beginning is the best way to ensure a safe and effective procedure and recovery plan. 

If you or someone you know is struggling with substance abuse or recovering from an opioid addiction, the [Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline](https://www.samhsa.gov/find-help/national-helpline) offers free and confidential help 24 hours a day, seven days a week. It can be reached at 1-800-662-4357.

*Patient names have been changed

Aesthetics

Pain management alternatives are more common than you might think.

Opioid-Free Anesthesia And Pain Management Options For Plastic Surgery Patients

Opioid-Free Surgery And Recovery: What Are Your Options?

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Unless you have the pain tolerance of a horse, there’s no getting around [topical numbing cream](https://aedit.com/aedition/everything-you-need-to-know-about-anesthesia) during many cosmetic treatments to make them more comfortable. Seemingly every procedure under the sun utilizes it, from [lasers](https://aedit.com/aedition/guide-to-ablative-laser-skin-resurfacing) and [injectables](https://aedit.com/procedure/dermal-filler-and-injectable-solutions) to [thread lifts](https://aedit.com/procedure/thread-lift), [microneedling](https://aedit.com/procedure/microneedling), and even [microblading](https://aedit.com/procedure/microblading) — the list goes on and on.  

Over the years, numbing cream has encountered its fair share of cautionary tales. In the early 2000s, reports of the cream were associated with life-threatening side effects, including irregular heartbeats, seizures, and even death (an extremely rare effect), due to abnormal amounts being applied. More recently, there's buzz saying that numbing cream can instigate [pimples](https://aedit.com/aedition/how-to-get-rid-of-a-pimple). Experts, however, are not convinced the anesthetizing agent is to blame.  

So, can numbing cream cause breakouts? Here, we get down to the nitty-gritty details to unearth the real story about the topical anesthetic and its ability — or inability (depending on many factors) — to be the cause of uninvited pimples.

## **How Numbing Cream Works**
Before launching into the debate at hand, here's a quick lesson on numbing cream and how it works. The first reported use of local anesthetic was back in 1860. Then, it was cocaine that acted as the leading anesthetizing agent; today, it’s primarily lidocaine. But lidocaine isn’t the only option. There are different types of ‘-caines,’ which are generally lidocaine, benzocaine, and tetracaine, or a combination of the three, says [Angela Lamb, MD](https://angelalambmd.com/), a board certified dermatologist in New York City. “Each has a different time of onset and lasts a different amount of time, so they are great to mix and give to patients for rapid effects and numbing that lasts long enough to make it through an entire procedure,” she explains.

If you’re curious how a topical on the surface of the skin can create a numbing effect, [Scott Paviol, MD](https://pavioldermatology.com/), a board certified dermatologist in Charlotte, NC, explains it this way: “The lidocaine in numbing creams works by blocking sodium channels which act to stop nerves from sending impulses.” Simply put, it stops the nerves from sending signals to the brain. “Whenever we perform procedures, we aim to make the experience as comfortable as possible for the patient,” he says. “Therefore, topical numbing is a great choice for a variety of procedures, including microneedling, lasers, and injectables.”

Applying numbing cream is pretty straightforward. It starts as a thin layer of cream-gel that starts to ‘melt’ (for lack of a better term) the longer it sits on the skin. In about five minutes, it begins to take effect. “However, the time we leave on the cream is dependent on the procedures,” Dr. Lamb says. “For injections, it normally sits for 15 to 20 minutes; laser resurfacing requires 30 to 60 minutes.”

It's essential to know that numbing cream is generally only effective in the areas where it is applied. Your doctor will remove the numbing cream after the skin feels numb. Then, the skin is cleansed again, usually with an alcohol wipe, to thoroughly remove any remaining residue. As a result, there should be minimal pain or discomfort with the treatment that's about to ensue — though patients may report minimal tingling or itching.

Some providers choose to give numbing cream to the patient to apply at home before their procedure to save time in the office, however, not every doctor agrees with this method. Dr. Paviol warns that it's vital for the person administering the topical numbing to understand how to use it appropriately and how to look for and manage any side effects. “If you use a medication without knowing how to use it properly, it can lead to unwanted side effects,” he says. “I do not recommend using topical numbing without the recommendation of how to use it from a medical professional, as it is possible to have systemic effects if not used correctly.”
 
## **Comfortably Numb… and Breaking Out?**
Sure, skin irritations and blemishes can arise from just about everything, and Dr. Paviol explains that the idea that numbing cream can induce [acne](https://aedit.com/concern/acne) isn’t as far-fetched as it seems. “Often, stressors, whether they are physical or mental, cause breakouts to the skin,” he says. That treatment you have planned and its numbing cream constitute stressors. “Putting numbing cream on the skin and performing a procedure puts the [skin into a state of stress](https://aedit.com/aedition/impact-of-stress-on-skin-acne-wrinkles-dryness) — purposefully injuring the skin to create the desired cosmetic effect — and this can cause the skin to break out for a few days after a procedure,” Dr. Paviol adds.

Even so, Dr. Lamb says that post-procedure breakouts are likely not happening because of numbing cream. “Post-laser folliculitis is very common, and, if you go to a good physician, they should know how to avoid this,” she notes. “I will not share my secret, but there is something that I give all my patients post-procedure to make sure this does not happen.”
 
Irritation and allergic reactions can also occur. There are different categories of numbing agents, Dr. Paviol explains, so it’s possible to be allergic to one and not another. “Typically, reactions are mild and self-limited and include redness, itching, and hives,” he says. But more severe reactions are possible, if rare. “That is why it’s important to be under the care and supervision of a medical professional who can help you to manage complications should they occur,” he reiterates.

If, by chance, a microscopic amount of numbing cream gets pushed into the skin by a needle or cannula, Dr. Lamb says there's no reason for concern. Any excess product shouldn't cause a breakout.

## **Post-Procedure Skincare Matters**
Post-treatment care holds as much weight as the procedure itself. When you sign up for a cosmetic procedure, you’re also choosing to actively participate in the healing process. “If you’re investing in a procedure, invest in the recovery from the procedure so you can get the best possible result,” Dr. Paviol says.

Depending on the treatment, your skin may be compromised afterward. The post-procedure recovery phase is all about [letting the skin heal properly](https://aedit.com/aedition/skincare-after-facial-plastic-surgery-procedures), which is why your doctor will give you specific care instructions that are important to follow. “Procedures stress the skin, and post-procedure care aims to let the skin rest, recover, and heal,” Dr. Paviol shares. As such, he says, bland emollients and post-procedure balms with no active ingredients are best to use. 

## **The Takeaway** 
So, while you may experience breakouts after an aesthetic treatment or procedure, don’t blame the numbing cream alone. “It is not common to have breakouts after the application of numbing cream, even though they do tend to be in a petrolatum base,” Dr. Lamb says. If you are concerned about [clogged pores](https://aedit.com/aedition/at-home-treatments-for-clogged-pores), just make sure the area is properly cleansed — it’s likely your provider has already taken care of this. 

Speaking of providers, it’s important to find someone who is highly skilled and trained in the procedure you are interested in. “I think some of what people are attributing to numbing cream breakouts is really post-procedure complications or a side effect from the procedure itself and physicians or spas don't know how to get ahead of this known, common, and expected post-op reaction," Dr. Lamb explains. 
 
If you continuously experience irritation or breakouts after a treatment, [talk to your dermatologist](https://broadway.aeditor.com/aedition/skin-care-questions-for-your-dermatologist) about your skin. “Chances are,” Dr. Paviol says, “any breakouts are from the stress reaction from the procedure itself and are short-lived and self-limited.”

So many aesthetic treatments use it, but can the topical anesthetic be the culprit behind pesky pimples? We investigate.

Does Topical Numbing Cream Cause Acne Breakouts?

Can Numbing Cream Make You Break Out?

mike-palmowski-ci-Lit-OEnY-unsplash

As the plastic surgery and aesthetic procedure industry continues to grow, so, too, does the demand for solutions that keep it as safe, simple, and affordable without sacrificing results. And many are answering the call with so-called ‘awake’ surgeries. Performed under local or regional anesthesia and often in combination with oral or IV sedation, awake procedures are a way to avoid pain and discomfort without [general anesthesia](https://aedit.com/aedition/everything-you-need-to-know-about-anesthesia). 

Some critics say providers are simply using the option in an attempt to bypass the role of the anesthesiologist for convenience’s sake, but the board certified plastic surgeons who offer such procedures see benefits that make it feel like the best option in some cases. Below, the basics of what you need to know about awake surgeries. 

## **What Is ‘Awake’ Surgery?**
While general anesthesia renders a patient fully unconscious, ‘awake’ options leave the patient, well, awake. But that doesn’t mean they are aware. Some procedures can be done with just local anesthesia (often lidocaine or a tumescent solution containing lidocaine, saline, and epinephrine) to numb the area being worked on. But many also involve twilight or IV sedation, which, as [Julius Few, MD](https://www.fewinstitute.com/), the board certified plastic surgeon behind The Few Institute in Chicago, explains, brings on a state in which “the patient is able to breath on their own for a comfortable, non-memorable surgical experience.”

And Dr. Few should know — not only does he offer awake procedures, but he also authored the [first peer-reviewed, large study](https://pubmed.ncbi.nlm.nih.gov/26446058/) on facial cosmetic surgery under local anesthesia with oral sedation in a fully accredited surgery center. “The procedures performed included [facelift](https://aedit.com/procedure/awake-facelift), [blepharoplasty](https://aedit.com/procedure/upper-eyelid-blepharoplasty), and even tip [rhinoplasty](https://aedit.com/procedure/nose-shaping-solutions),” he says. The results showed the option to be safe.

## **Why Stay Awake?**
There are a few major reasons a patient may prefer the ‘awake’ route. The first is to simply to mitigate any fear that arises about the concept of going under. After all, there are complications associated with general anesthesia that run the gamut from nausea to ([very rarely](https://health.clevelandclinic.org/safe-anesthesia-5-things-know/)) death. And then there are certain conditions that may make going ‘awake’ the better option for your health. “Risk factors for general include allergies to anesthesia, diabetes, heart disease, high blood pressure, kidney problems, lung conditions, and obesity,” Dr. Few notes.

But it’s not as if one type of anesthesia carries potential side effects while the other does not. While local anesthesia is generally considered to have lower risk of complication, “[it] needs to be managed very carefully, as there could be toxic side effects of overuse,” explains [Kevin Tehrani, MD](https://aedit.com/provider/kevin-tehrani-md-91), a double board certified plastic surgeon of Aristocrat Plastic Surgery in New York City. He does, however, see a psychological upside for some patients. For those more anxious about the outcome of their surgery, “the biggest benefit is one’s perception of not giving up control,” he says. 

In some cases, surgeons actually feel the awake patients leads to better results. Thomas Su, MD, founder of [Art Lipo Arm Liposuction & Plastic Surgery Center](https://artlipo.com/) in Tampa, FL, exclusively offers what he calls “interactive lipo.” “I actually stand my patients up after completing part of the surgery to check my results because gravity and laying on the table distorts what you can see,” he shares. His method of awake surgery skips sedation via Valium or Xanax so his patients can, as he explains, “move in different positions and also hold their muscles tight and firm.” This allows for “much better control during the sculpting,” he adds. 

Dr. Tehrani sees similar benefits. “[For] more limited areas like [arms](https://aedit.com/aedition/cosmetic-procedures-for-slimmer-sculpted-arms) or buttock liposuction, I prefer [operating] under local anesthesia, as I like to have the patients actually activate their muscles so I can sculpt around it,” he says.

And then there’s the [cost savings](https://broadway.aedit.com/aedition/how-much-cosmetic-surgery-costs). If you opt for local anesthesia alone, it’s cheaper, as it doesn’t require the presence of an anesthesiologist. In some cases, the same is true of twilight sedation. Dr. Few understands this can be an alluring benefit for patients, but he warns to not make cost a primary deciding factor. “Bottom line, I will never put financial consideration ahead of patient safety or comfort,” he emphasizes. “If general anesthesia is needed, it is needed.”

## **What Procedures Can Be Performed Awake?**
The treatments doctors offer as awake surgeries vary, however, they tend to be in finite areas. “In general, smaller areas are preferred under local anesthesia, so that the extent of anesthetic given does not get to a toxic level,” Dr. Tehrani says. Common examples include:

- Awake facelift
- Awake blepharoplasty
- Awake liposuction (neck, arms, buttocks)

Some [research shows](https://journals.lww.com/annalsplasticsurgery/fulltext/2019/10000/aesthetic_breast_surgery_under_cold_tumescent.6.aspx) that breast surgery can also be safely performed under tumescent anesthesia as well. To mitigate risk as much as possible at his own practice, “general anesthesia is reserved for more aggressive surgical cases that involve complex or multiple treatment areas,” Dr. Few says. That includes full body liposuction, [mommy makeovers](https://aedit.com/aedition/the-mommy-makeover-how-to-bounce-back-after-a-baby), and body lifts. “These kinds of surgical procedures require significant commitment overall,” he adds.

## **What to Expect From Awake Surgeries**
Though the area is numbed, there may be some level of pain involved with awake procedures. It is similar to what you might feel at the dentist. Here’s how Dr. Su breaks down the experience of his awake, local-only liposuction treatments: “During the procedure, there is some stingingness and weird movement sensations while the local anesthetic is being dispersed in the fat layer.” Once the fat layer is numb, he says there may be “occasional stings” during the liposuction step, but it is generally “pretty tolerable.” Additional lidocaine may be able to be administered, but it’s rarely necessary. “Fortunately, the instances where patients really don't tolerate this well is fairly infrequent,” he shares.

After surgery, he says, “the local anesthetic provides a more comfortable gradual tapering off of anesthetic compared to general, which wears off very quickly and leaves patients needing pain medication immediately.” For those who combine local anesthesia with IV or oral sedation, you’ll be awake but, well, out of it. [When administered correctly](https://www.surgery.org/consumers/plastic-surgery-news-briefs/patient-safety/awake-aware-undergoing-surgery-1031012), the patient comes away with no memory of their procedure.

## **Are You a Candidate for Awake Surgery?**
Ultimately, the type of anesthesia you receive comes down to what you and your surgeon think is best. If your doc provides a local option for the procedure you’re having done, a few questions should help him or her determine if you might be a candidate. The first often goes back to that dental analogy. “Typically, I ask about their dental anesthetic experience in the past and whether or not that’s been something that he or she has tolerated well,” Dr. Tehrani says. That will give you some indication of whether you might experience discomfort. 

Dr. Su also makes sure to get a feel for how skittish a patient is. “If there is a downside to awake liposuction, it is that the occasional very nervous or anxious patient may have a more difficult time during the surgery,” he cautions. “If someone thinks that they are too scared, they have a choice and may be better off being put to sleep.” Beyond that, “the requirements to safely do liposuction awake are not much different than doing any other plastic surgery,” he says.

## **How to Find a Provider**
The first rule of plastic surgery is to look for a [board certified provider](https://aedit.com/aedition/medical-board-certification-in-plastic-surgery-cosmetic-dermatology) who offers both general and local anesthesia. That way, you can be sure you’ll have access to what’s best for your needs. Beyond that, do your research. “There are reports of bad experiences with all surgeries whether awake or asleep,” Dr. Su says. His advice: Ask to see lots of before and after images. “The more results and the better the quality of photos, the more believable,” he shares. “And videos of live patients with their actual results is even more impressive and indisputable.”

All about the trend of aesthetic procedures done with local anesthesia.

A Guide To Awake Plastic Surgery Procedures Without General Anesthesia

Awake Surgeries: What To Know About Not Going Under

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Doctors and patients alike are continually searching for ways to make the surgery experience more comfortable. One of the key components to comfort or the lack thereof is anesthesia (i.e. how — and to what degree — a patient is desensitized and/or sedated during a surgical procedure). Generally speaking, there are [four main types anesthesia](https://aedit.com/aedition/everything-you-need-to-know-about-anesthesia): 

- **Local Anesthesia**: Desensitizes a small area of the body  
- **Regional Anesthesia**: Numbs a specific part of the body, but a larger one than possible with local anesthetic
- **Conscious Sedation**: Sometimes referred to as twilight sedation, is used for short procedures or when regional anesthetic would not be effective
- **General Anesthesia**: Patient is unconscious 

Each of these options comes with a particular set of characteristics, risks, and applications and are widely used in medical and aesthetic surgeries and procedures. There is, however, a fifth technique that has been gaining popularity in recent decades — though there is nothing new about it. Hypnosis has been used to lull people into a semiconscious state for centuries, and it is now making its way into operating rooms around the globe. So, how and why is this ancient practice making a comeback in modern medicine? The AEDITION asked the experts.

## **The History of Hypnosis**
There is evidence of hypnosis being used as a healing aid by early Hindus, who took their sick to the temple to meditate overnight. Published in 1027, a Persian text called *The Book of Healing* was the first to distinguish between sleep and hypnosis. In subsequent centuries, physicians and scientists studied and honed their ‘healing’ techniques, sometimes using religious relics or magnets to ‘cure’ patients.

In the eighteenth century, German doctor and amateur astronomer Franz Mesmer developed his [theory of animal magnetism](http://www.historyofhypnosis.org/), which hypothesized that all living things possess an energy that could be harnessed by a practitioner for healing. Though his ideas were dismissed as imagination rather than science, Mesmer’s followers continued his legacy and the term ‘mesmerize’ remains.

A century later, Scottish surgeon James Braid sought to debunk the work of Mesmer’s successors by exposing the fraud in their traveling demonstrations. But Braid couldn’t get past one irrefutable fact: None of the mesmerized subjects could open their eyes after staring at a bright object for eight to 12 minutes. Intrigued, Braid set about his own experiments to see if he could replicate the experience himself without magnets, operators, or guides. Braid successfully hypnotized himself, giving rise to the modern “[pyscho-physiological](https://www.ncbi.nlm.nih.gov/pubmed/7001980)” (read: mind-body) theory of hypnotism.

In 1829, French surgeon Jules Cloquet performed the [first documented use of hypnosis as anesthesia](https://hypnosis.edu/history/the-pioneers-of-mesmerism) during a mastectomy in Paris. The technique was first used in America [during dental surgery in Boston](https://www.tandfonline.com/doi/abs/10.1080/00029157.1988.10402733) by dentist Dr. Harwood in 1836, and, three decades later, by field surgeons during the Civil War. Despite the successful cases, the discovery of ether as anesthesia in the mid-19th century proved to be a game-changer for sedation. Compared to hypnosedation, the drug was quicker and more reliable, as not every patient can be successfully hypnotized.

## **Hypnosis Makes a Comeback**
While pre-op hypnotherapy fell out of favor, it never went away completely. In 1992, anesthesiologist [Marie Elisabeth Faymonville](https://esh2017.org/marie-elisabeth-faymonville) and colleagues at Belgium’s University of Liege began experimenting with a combination of local anesthesia, conscious IV sedation, and hypnotherapy during breast cancer treatment and other surgeries. To date, the team has performed over 9,000 operations under hypnosis and completed several clinical studies. Results show a significant reduction in both perioperative pain and anxiety, decreased reliance on post-operative medication, and a quicker recovery time from anesthesia.

Breast surgery has a high incidence of chronic post-operative pain — pain that lingers for months, or even years, after a procedure. The degree of perioperative pain (i.e. how much pain a patient experiences immediately after surgery) is also a risk factor for chronic pain. In other words, patients who feel less pain surrounding their procedure tend to have less pain long-term. 

One [European clinical trial](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5011203/) followed two groups of similar breast cancer patients: one who received general anesthesia and one who received local anesthesia and intravenous sedation with hypnosis. Immediately after the procedure, those who had the local anesthesia/hypnosedation combination experienced significantly lower pain and anxiety levels. In the four years that followed (the duration of the study), they saw decreased levels of chronic pain and better range of motion. Researchers admit that more data is needed, but the idea is worth exploring further. 

### **Hypnosedation in the United States**
At the MD Anderson Cancer Center at the University of Texas, doctors are [conducting clinical trials](https://www.mdanderson.org/publications/conquest/conscious-decision-in-operating-room.h34-1592202.html) using similar techniques — combining local anesthesia, conscious sedation, and hypnosis. Initially, the researchers had to overcome some cultural preconceptions surrounding hypnosis. While many people are under the cartoon-inspired assumption that hypnosis will have them clucking like a chicken, it actually allows people to dissociate with reality and enter a deeply relaxed state.

One study focuses on women undergoing breast biopsies and lumpectomies (i.e. the removal of tumors and a margin of surrounding breast tissue). The surgical team includes a breast surgeon, a mind-body specialist, and an anesthesiologist standing by to administer general anesthesia if necessary. Patients are asked to focus on a place of deep relaxation and comfort. They remain conscious, but in a dissociated state — like driving on autopilot — and avoid some of the side effects of general anesthesia (think: grogginess, nausea, and vomiting). In some instances, patients participating in the trial exhibited a decreased dependence on opioids, both during and after surgery.

## **Hypnosedation for Plastic Surgery**
While hypnosis for plastic surgery is uncommon in the U.S., providers are open to the idea. “This will work really well on certain people, as long as you pre-screen patients to make sure they’re amenable to being hypnotized,” says [Jason Roostaeian, MD](https://aedit.com/provider/jason-roostaeian-md-449), a board certified plastic surgeon at UCLA. 

He’s quick to point out, however, that general anesthesia does not deserve the bad rap it often receives. In most cases, it’s used in combination with local anesthetic to keep doses lower, and, in his opinion, sedation is actually the riskier option. “With general, we can control your breathing because there’s a tube down your throat to keep you alive,” Dr. Jason explains. “But with sedation, there’s a fine line between relaxing someone for surgery and creating a situation where there’s breathing issues.”

Nashville-based board certified plastic surgeon [Jacob Unger, MD](https://aedit.com/provider/jacob-unger-md-2649), agrees that unconscious sedation serves a purpose. “During particularly long procedures or procedures where the airway can be compromised, general anesthesia is the safest option,” he says. “The surgeon and whole surgical team have better control of the patient's hemodynamics and airway.”

### **When Hypnosedation Is Appropriate**
In healthy patients who are appropriate candidates, both surgeons see the potential for hypnosedation in plastic and reconstructive surgery procedures. “Smaller or regional procedures that can safely be performed without medical airway control can be done under local combined with relaxation techniques,” Dr. Unger says, adding that the technique “can aid in rapid recovery.”

Dr. Jason says he would consider using hypnosis during [breast augmentation](https://aedit.com/procedure/breast-augmentation-with-implants), [facelifts](https://aedit.com/aedition/popularity-of-facelift-cosmetic-surgery-for-aging-sagging-neck), [upper blepharoplasty](https://aedit.com/procedure/upper-eyelid-blepharoplasty), and even for more invasive and stimulating procedures like [liposuction](https://aedit.com/procedure/tumescent-liposuction) and [abdominoplasty](https://aedit.com/procedure/abdominoplasty). He’s generally open to working with patients who — for medical necessity or personal preference — want to avoid general anesthesia. “I have the same conversation with each of them,” he shares. “I make sure they know that sedation makes me inherently less efficient than general because I’m having to focus on the patient moving or being uncomfortable.”
 
Dr. Unger agrees that combination therapies require more thought and coordination. “Plastic surgery, in general, focuses on superficial organ systems such as skin, fat, and some occasional muscle work,” he explains. “These can be typically anesthetized with local numbing agents, such as lidocaine, but it can be challenging to keep people calm and control their pain for an extended period of time.” Even so, “with judicious use of medicine and a well-formulated plan, many things can be done under local,” he says.

To keep conscious or semi-conscious patients comfortable during cosmetic surgery, Dr. Unger creates a [tranquil OR environment](https://aedit.com/aedition/unexpected-things-to-know-about-the-plastic-surgery-operating-room). “We put on soothing music and talk in calm, low, and consistent volume voices,” he shares. “It tends to make patients so relaxed they fall asleep during the procedure. It’s so calm.”

## **The Takeaway**
While still experimental, the researchers at MD Anderson are optimistic about the potential hypnosis has to help patients recover faster (with less medication and fewer side effects). Plastic surgeons agree that the method could prove effective for patients who are amenable to the technique and better equipped to manage feelings of pain naturally.

Now Trending

Hypnosis has been used to lull people into a semiconscious state for centuries, and it is back in ORs around the globe. So, how and why is this ancient practice making a comeback in modern medicine? The AEDITION asks the experts.

The Future Of Hypnosis And Hypnosedation As Anesthesia In Plastic Surgery

Is Hypnosis The Future Of Sedation In Plastic Surgery?

shutterstock 106821317-min

For most people considering a cosmetic procedure, one of the biggest concerns is going under anesthesia and the potential risks associated with it. The good news is that modern cosmetic surgery often allows for different types of anesthesia and, while general anesthesia should not always be looked upon as a risky option, patients can be offered a choice of anesthesia and how awake they want to be during their procedure. But even if you are considering a minimally invasive procedure, you will likely be given some form of anesthesia in order to make the procedure as comfortable as possible.

Anesthetics are drugs administered to reduce sensitivity to pain. There are many types of anesthetics, from topical numbing creams to drugs that are administered intravenously (through an IV). The type of anesthetic drugs used in any given procedure will largely depend on the type of surgery being performed, but the goal of an anesthetic is always to keep the patient comfortable and to allow the practitioner to do their work without causing pain. Common anesthetics fall into four categories.

## **1. Local Anesthesia**
Many types of procedures can be carried out using only local anesthesia, which targets a small area of the body. Drugs are usually administered by individual injection around the area that will be treated, so the most discomfort you will feel during the procedure will be those initial pinpricks. After that, you may experience some pressure while the medical procedure is carried out, but you should not feel any pain. Local anesthesia allows the patient to be fully awake and alert during the treatment and most people have their first experience of local anesthesia at the dentist’s office when having a minor procedure.

### **Benefits of Local Anesthesia**

- Minimal downtime
- Less preparation before your procedure
- Fewer side effects
- Ability to go home shortly after the procedure

The biggest benefit of local anesthesia is a reduction in downtime by reducing the chances of side effects, including nausea and vomiting that can be associated with other types of anesthesia. And since the patient remains fully conscious during the process, it allows those who have a procedure under local anesthetic to go home on the same day and return to their normal activities quickly. 

The decision to use local anesthesia will depend on a number of factors, including the nature of the procedure, your medical history, and your personal choice. Local anesthesia can sometimes be combined with sedation, especially if you are a nervous patient who could find it distressing to be fully alert during a procedure. 

## **2. Regional Anesthesia**

Regional anesthesia is a form of anesthetic that numbs a specific part of the body, but a larger area than possible with local anesthetic. The most commonly known form of regional anesthesia is the type used during childbirth: the epidural. But that is not the only form of regional anesthesia and the technique can be used for procedures on the [abdomen](https://aedit.com/procedure/mini-tummy-tuck), [lower limbs](https://aedit.com/procedure/thigh-lift), or even the [arms](https://aedit.com/procedure/arm-lift). It’s a popular option for patients who have a medical history that would make a general anesthetic a higher risk. 

### **Benefits of Regional Anesthesia**

- Suitable for invasive surgeries
- Allows the patient to remain conscious
- Can be safer for some people depending on their medical history
- Less downtime than general anesthesia

Regional anesthesia provides a viable option for patients who aren't suitable for (or don't want to have) general anesthesia to have more extensive surgery. While the drugs that provide regional anesthesia do not sedate the patient, many opt to have sedation in conjunction with nerve blocking or epidural pain relief in order to stay relaxed throughout the procedure. 

This type of anesthesia also provides pain relief for the immediate post-surgery period, but other drugs are commonly provided to ensure that you are as comfortable as possible during recovery. Downtime from regional anesthesia varies, but depending on the nature of the procedure patients may be able to go home on the same day. Once the drugs wear off, normal function generally returns, though regional anesthesia does come with some risks, like an allergic reaction. Rarely, complications occur with epidural and spinal injections that can result in temporary or long term paralysis, but your surgeon and anesthetist should discuss all risks with you when presenting anesthesia options.

## **3. Monitored Sedation**
Monitored sedation is used in cosmetic surgery to ensure pain management and to keep patients comfortable during surgery, but you may have also come across it during diagnostic testing. Monitored sedation, sometimes referred to as twilight sedation, is administered intravenously and, according to the American Society of Anesthesiologists, is used for shorter or less complex procedures or when regional anesthetic would not be effective.

### **Benefits of Monitored Sedation**

- You will be drowsy or asleep during the procedure
- Suitable for daytime surgery
- Can be a good option for anxious patients
- You will not be unconscious at any point

Sedation is a versatile form of anesthesia which makes it popular within the cosmetic surgery industry. It has fewer risks associated with it than general anesthesia, but can provide enough pain relief to be able to carry out complex procedures without putting patients under general anesthetic. There are several levels of sedation and the level required will depend on a number of factors, including the type of procedure being performed. The primary levels of sedation are:

- **Minimal**: Minimal sedation helps patients to relax, but they generally remain awake for the procedure. The doctor will be able to ask you questions and you will be able to follow directions as needed. 
- **Moderate**: Patients feel drowsy during moderate sedation and may fall asleep during the procedure. You will be able to remember some or all of the procedure and will be aware of time passing.
- **Deep**: Patients under deep sedation are asleep but not unconscious. You would have little or no memory of the procedure and may feel more tired than usual upon waking.

A procedure under sedation must involve the presence of an anesthetist and you may have a consultation with them before your procedure. They will take into account several factors to establish which level of sedation is appropriate, including your age, general state of health, the nature of the procedure, and your medical history.

## **4. General Anesthesia**
General anesthesia is the best known form of anesthetic and is used for major procedures. General anesthesia is administered using either a mask or IV drip. While under general anesthetic, the patient is unconscious and some of the body’s functions slow down, which makes it easier for surgeons to perform surgery. That also means that you will not feel any pain or have any memories of the procedure. During the procedure, nurses and anesthetists will monitor your vital signs, including your blood pressure, and adjust the amount of anesthesia accordingly.

### **Benefits of General Anesthesia**

- Allows for extensive surgery to be carried out safely
- You will have no memory of the surgical procedure
- Allows the medical team to have control of your airways

While you may be able to return home on the same day as having surgery under general anesthesia, you will not be allowed to drive. It is common for patients who have a procedure requiring general anesthesia to remain at the hospital or clinic overnight, so that the [medical team can monitor pain](https://aedit.com/aedition/finding-the-right-plastic-surgeon-dermatologist-or-cosmetic-dentist) and other symptoms to ensure it is safe for you to return home. Side effects are more common with general anesthesia than with other forms of sedation or anesthesia. These often include nausea, vomiting, dizziness, and, while rare, allergic reactions to the drugs used. 

## **The Takeaway**
The type of anesthesia used during a cosmetic procedure will depend on a number of factors, but primarily the nature of the procedure and your medical history. Beyond this, you may be offered a choice of options, and those who anticipate being anxious during the procedure may wish to opt for a greater level of sedation. These days, complications from all forms of anesthesia are rare, but they do remain a possibility. Your physician should always discuss any risks with you. Full details of your medical history and allergies will be taken during your preoperative appointments to limit these risks as much as possible, but if you have any questions or concerns your medical team will be able to discuss them with you.

Wellness

For most people considering a cosmetic procedure, one of the biggest concerns is going under anesthesia. Here's what you need to know.