Newport Faces

Surgery with Local Anesthesia and Sedation

During training, surgeons learn most of their procedures with the patient under general anesthesia. This permits the surgeon to focus solely on the surgical techniques. General anesthesia involves placing a breathing tube to secure the airway and delivering a combination of gases using a ventilator to breathe for the patient. Gas anesthetics and other medications keep the patient unconscious and unresponsive to painful stimuli. In the otherwise healthy patient this is relatively safe when performed under the care of an experienced anesthesiologist. There is a recovery period where the patient needs to be closely monitored until normal reflexes return. Depending on the duration of anesthesia, the effect of the gases on the various organ systems may take several days before complete return of normal function. This technique is essential for lengthy procedures or in areas when local anesthesia is insufficient to block sensation. Preexisting health conditions pose the greatest risk and careful observation is essential until vital reflexes return.

Local anesthesia involves injection of nerve  blocking medication into specific regions of the body. While some of the medication is absorbed and metabolized,  safe concentrations produce minimal  effect on other organ systems. This works well for procedures that can be accomplished in shorter periods of time.  With surgical efficiency and the discovery of dilution techniques, it became possible to safely and comfortably accomplish more surgical procedures than before.  About 15 years ago, Dr. Fink started using local anesthesia exclusively for certain facial rejuvenation procedures. He found that combining  oral sedatives with efficient procedure times (usually under 4 hours), he could comfortably accomplish many procedures in one session.  There was a learning curve to safely titrating the optimal combination of sedation medications.  Injection technique also helps to keep patients comfortable.  Patients often doze off during parts of the procedure while listening to relaxing music. Although they remain arousable at all times, many recall only limited parts of the procedure.  Dr. Fink has found several other advantages using this technique. While patients are conscious, they maintain muscle tone. This lessens the risk of deep venous thrombosis. The ability to change positions and animate  the face and neck can assist in positioning and makes it easier for Dr. Fink to gauge certain aspects of the surgery on the appearance.  Although patients need a ride home and are usually sleepy for much of the day of surgery, patients recover faster from the sedation and most wean off pain medications within  24-48 hours.  Although the thought of being conscious during surgery may not be for everyone,  a patient can be less aware with  IV sedation and an anesthesiologist as a good alternative to general anesthesia. This permits the use of more powerful medications  that work faster.  Doses can be adjusted to an intermediate level of awareness while providing  a greater degree of amnesia.  Although patients are given their choice of anesthesia, Dr. Fink still performs more than 90% of his procedures using local anesthesia with oral Sedation. He has safely and skillfully performed over 4000 facelifts and many other procedures using this anesthesia technique. 

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