What about anesthesia? 

The surgery we want to do cannot be done without some form of anesthesia.

Anesthesia means making the patient comfortable and free of discomfort during and after the operation.

The most important thing about anesthesia is safety. Everything about an operation and the anesthesia required must be safe.

For the operations we perform, in cosmetic surgery, the anesthesia has the potential of being more dangerous than the operation itself.

Since the anesthesia and how it is administered usually presents more risks and hazards to the person having surgery than the surgery itself, it is best not to turn the patient's safety over to another person, such as a nurse anesthetist or some other doctor who is not well known by the patient.

I know of cases that have had severe complications from colleagues who otherwise were very good board certified surgeons themselves, but who have turned over the anesthesia and care of their patients to registered and certified anesthetists and board certified anesthesiologists. Personally, I cannot see taking that kind of unnecessary risk for patients. From my experience, the patient is better off when I am responsible for their care and comfort, rather than someone else.

Therefore, for those persons who give me their trust and confidence, by choosing to come to me to have elective cosmetic surgery performed, I prefer to assume the responsibility for their safety and comfort.  

With this type of anesthesia, a promise is made to the patient that there will be no pain greater than a mosquito bite. Even to start the IV we numb the arm with a local anesthetic, and the patients are assured that they will feel no other injections and no other pain. (see anesthesia questionnaire ).

Most of the patients go home feeling weak and somewhat intoxicated, as would a person who had a couple of martinis to drink.

Although we are prepared for significant complications, such as anesthetic reactions, heart attacks, strokes, and other such events that would require resuscitation, or transporting the patient to the hospital, such events have never occurred with our surgery, and of course, we hope they never will.

Some of our patients, however, are over 65 years old and already know they have health problems, such as heart disease. We study the procedures and the risks very carefully with them as with all patients, and confer with their doctors as to the advisability of cosmetic operations when needed. Even in these persons with significant known health problems, to date we have had no serious or significant complications.

Experience with anesthesia 

It was while in training in Southwestern Medical School that I was first taught surgical principles and the use of local anesthesia during the removal of lesions and the repair of injuries in the emergency room of the Memorial Hospital in Dallas, Texas. It was my good fortune to be able to work there through the summer in addition to attending school.  

Then, at the USC medical center in Los Angeles, the Goldman course of cosmetic nasal surgery was taught to me, along with face-lift principles and cadaver dissection by prominent Los Angeles cosmetic surgeons. 

In the Air Force, the use of local anesthesia was continued as needed for outpatient surgery. At the University of Colorado, local anesthesia with sedation was used for formal elective surgery performed in the surgical theatre of the University, very similar to the way we do it today. It was at that time I first began performing cosmetic surgery in training, especially under the guidance of Dr. Leroy Kinney (a retired captain of the navy) and many others on the staff at the university.

At the University of Colorado, I studied the principles and practice of anesthesia as a resident in anesthesia in the Department of Anesthesia chaired by Dr. Robert Virtue. And during that time, I had the opportunity to work with and provide anesthesia for many exceptional surgeons, including Dr. Thomas Starzl who, while there, performed the world’s first liver transplant. 

Though we have all the modern equipment, monitors, and medicines and have kept up with modern knowledge and techniques, the type of anesthesia administered today is very similar to that used 25 -30 years ago simply because it is safe and it works. The patients are comfortable and they like it. It is tried and true.

For more than 10 years now, we have used an anesthesia questionnaire for all patients on whom we start an IV to give sedation. No patients are left out of the questionnaire. And it is used on everyone for every procedure. Since we have been using it for so long, we have the patients’ answers to all the standard questions regarding comfort level, memory of any thing, how they felt, etc. 

And in summary, more than 98% of our patients have said that they had a pleasant experience with the anesthesia.  (see anesthesia questionnaire ).

In addition to this, we have a perfect record of safety, meaning that no patient on whom we have done surgery has needed hospitalization or has experienced any serious emergency. 

Local anesthesia means the area being worked on is made numb, so that there is no feeling. This means the work being done is painless, just as a haircut is painless. Therefore, not as much sedation is needed for the patient to sleep.

When we get a haircut, for example, we do not feel any pain with the actual cutting of the hair. The hair is numb and has no sensation. If it is pulled on, of course it hurts. So the person cutting our hair is careful not to pull on the hair, and we expect to have no pain with a haircut.

A child getting his first haircut up to age four or five, without being prepared, will sometimes be terrified and cry when he hears the scissors cutting his hair. This can be equally unpleasant for the barber as well as the child, especially if the child is unable to accept the parents' reassurances that the experience will be painless and harmless. Sometimes it is best for the barber to let the child go home without a haircut rather than subject him to a terrifying experience.

We feel the same way. If a person cannot accept reassurances that the surgery is going to be painless, then rather than have an unpleasant experience, they should consider general anesthesia, or no surgery at all, since I believe general anesthesia is so hazardous.

General anesthesia means that the person is made completely unconscious so that even if there is an operation performed on them, they will not be aware of feeling any thing. This usually requires a breathing tube in the throat, and someone to breathe for the patient the entire time. Not only is general anesthesia much more hazardous to the person’s life, but there is a much higher incidence of complications, such as nausea and vomiting, from general anesthesia. In other words, it is much more likely to make you sick.

Local anesthesia is much safer than general anesthesia. All of the operations we do are performed under local anesthesia. In addition to having no pain, because the area we are working on is numb, our patients are given a tranquilizer and a narcotic (such as valium and demerol) to make them comfortable and as sleepy as they would like to be. Our patients are always arousable and not made so sleepy that they cannot be aroused.

If our patient is awake and wants to be more asleep (and says so), more medicine can be given in small amounts until the right amount is given for each patient to keep the him/her happy and comfortable and, in most cases, allow them to sleep through the entire operation with no memory of any of it.

Under an umbrella of safety (safety first at all times), it is our goal that all of our patients have a very pleasant experience with their surgery, so much so that we routinely ask our patients if they had a good time before they go home, and the patients routinely respond that yes, they did.

What are the risks and hazards of anesthesia?

Our experience with the administration of this type of anesthesia dates back to when we first started using it in training, and we have over thirty years experience with surgery and local anesthesia.

In over 20,000 patients with this type of anesthesia, we have had no serious ill effects. This does not mean that we will not ever have any serious complications. Anyone can have a heart attack at any time. This possibility is very real, as many of our patients are in the age range when heart attacks are common, whether surgery is conducted or not. 

The medicines needed for an emergency are always available. They are those that will counteract the anesthetic medicines, and those that are needed for resuscitation of the person who has had an emergency such as a heart attack.

These medicines and the equipment required are widely known and standardized by the American Heart Association in the instruction courses they teach called Advanced Cardiac Life Support (ACLS).

To be sure that we are current on the most modern techniques and have the medicines and equipment recommended by the American Heart Association, I became an ACLS instructor in 1978  from an instructor course at Cedars Sinai Medical Center of Los Angeles through the American Heart Association. 

Having been an instructor of ACLS continuously since 1978 teaching 4-5 AHA approved courses per year, I have taught and\or been course director of more than 100 ACLS courses to date, and continue to teach them several times every year. The last one taught was in June 2001. All of our medical assistants also are current with valid cardio-pulmonary training certification from the American Heart Association.