Awake plastic surgery vs procedures with general anesthesia

Most of us imagine being asleep and entirely unaware of what's happening when we think of having surgery, but for some procedures – and the right patient – awake plastic surgery may be an option.

What exactly is awake plastic surgery, and how does it differ from procedures with general anesthesia? We're getting into the key differences and more with the help of ASPS Member Surgeon Michele Shermak, MD.

What is awake plastic surgery? How does it work?

During awake plastic surgery, patients remain conscious, able to move and respond to the surgeon throughout the procedure. If this sounds terrifying, know that there are measures in place to manage your pain as well as keep you comfortable and safe during the procedure.

Awake plastic surgery is performed using a combination of local anesthesia to numb the area, pain medication and either an oral or inhaled sedative to reduce anxiety and keep you relaxed during the procedure.

You shouldn't feel any pain, but you will be aware of what's happening around you.

How does surgery with general anesthesia work?

During a procedure under general anesthesia, which Dr. Shermak said is much more common in her practice and in most others, the patient is fully asleep.

A board-certified anesthesiologist administers general anesthesia via an IV, a mask or both. Once you're asleep, a breathing tube is placed. The anesthesiologist monitors your vital signs throughout the entire procedure and for a while once you're in the recovery room.

You're unconscious while under general anesthesia and don't feel anything during surgery, and have no memory of it when you wake up. People typically feel very groggy and sleepy when the procedure is done, which is why you're not able to drive yourself home after surgery.

The benefits of awake plastic surgery

Awake plastic surgery isn't suitable for every procedure or every patient, but there are some clear benefits for those who are able to have it.

"Strategic application of numbing medication typically allows patients to tolerate procedures well while awake," said Dr. Shermak.

This means that patients are not only conscious and able to interact with the surgeon during the procedure, but also comfortable throughout the process.

Recovery after an awake procedure is also notably smoother, with "easy recovery from the 'get go' with little to no time needed in the recovery room," and for most procedures, "patients can drive in and drive home, unless working on the eyes."

Opting for an awake surgery over a general anesthesia procedure is also less expensive and is optimal for patients with medical conditions that make general anesthesia riskier. These include conditions such as heart disease, obesity, obstructive sleep apnea and lung conditions.

Why awake plastic surgery isn't for everyone

While it has its perks, not everyone is a good candidate for awake plastic surgery. Dr. Shermak noted that it's not suitable for "procedures that take many hours to perform" or those requiring "more comprehensive pain management, such as that offered by a certified anesthesia provider."

It's also important to remember that while you're comfortable and don't experience pain during awake plastic surgery, you'll be privy to all the sights and sounds of surgery. Patients who are particularly anxious may find the idea of being awake during surgery too unnerving, making them unsuitable candidates.

Talking to your surgeon about your anesthesia options

Awake plastic surgery has advantages, but it's important to book a consultation with a board-certified plastic surgeon for guidance. Ask about your anesthesia options based on the type of procedure you're having and your medical history.

Remember that your comfort level is an important consideration when choosing the type of anesthesia for your procedure. If you're squeamish, don't hesitate to say so. This is the time to share your concerns and be honest about any anxiety you're experiencing. Together, you and your surgeon will choose an option you both feel good about using.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.