Anesthesia and Cosmetic Surgery

 

One of the biggest humanitarian innovations in the history of civilization was the discovery of anesthesia.  Prior to the discovery of ether anesthesia in the 1840’s, people were pretty much tortured during surgical procedures and “bitting the bullet” had a very literal meaning.  The best Civil War battlefield surgeons were those who could most rapidly remove a limb.  Fast surgery was very important at one time.  The first part of the 20^th Century ushered in the discovery of local anesthetics with Novacaine being the first agent.  This was another huge advance as it made anesthesia “portable” safer and provided patients with another surgical anesthetic option.  Prior to this, having a mole removed or a tooth worked on was a tough deal!

We are lucky to live in an era of multiple anesthetic options for cosmetic surgery.  General anesthesia is the deepest form of surgical anesthesia.  This technique is defined by an unresponsive patient that cannot follow commands and requires assistance with life support.  Although the lighter anesthetic procedures allow the patient to breath on their own, the deeper techniques “breath for the patient” by using a ventilator on the anesthesia machine.  A breathing tube is frequently placed through the mouth or nose and through the vocal cords to enable the oxygen and anesthetic gases to enter and the carbon dioxide to be exhaled.  Although some cosmetic procedures are better performed with general anesthesia, there has been a giant trend to not use such deep anesthetic techniques.  Many surgeons feel that general anesthesia adds additional risks with cosmetic surgery.

The second type and most common anesthetic technique is IV sedation or M.A.C. (monitored anesthetic care) anesthesia.  With IV sedation the patient does not need a breathing tube and breaths on their own the entire case.  IV sedation can be light, where the patient is relaxed and can respond to commands, or deeper where the patient is totally unconscious.  MAC anesthesia is a very safe technique and is “fast on and fast off” meaning that the patient quickly is sedated then quickly wakes up when the drugs are stopped.  Many patients have had experience with this type of anesthesia from wisdom tooth surgery or colonscopy.  Newer drugs decrease the post anesthesia sickness, nausea and vomiting seen in the past.  For general anesthesia and IV sedation the patient must refrain from food or water for about hours before surgery.

Oral sedation is another option and involves taking a sedative pill before the procedure.  Although this relaxes the patient, it does little for pain control so local anesthesia must be used as well.

Tumescent anesthesia involves mixing saline with the local anesthetic Lidocaine and very small amounts of epinephrine.  This is most frequently used for liposuction and facial surgery procedures.  This mixture enables pain control and reduces bleeding.  Tumescent anesthesia has revolutionized cosmetic surgery anesthesia as many procedures may be done with this type of anesthesia, totally awake.

Local anesthesia is another popular form of awake anesthesia and is the same mechanism as going to the dentist.  Eyelid surgery and other cosmetic procedures are sometimes performed with only local anesthesia.  Local anesthesia or tumescent anesthesia is also frequently used with general anesthesia and IV sedation to enhance pain control.  This also reduces the amount of anesthetic agents necessary to keep the patient asleep as well as keeps the patient numb for a while after they awake.

Most anesthetic techniques are very safe and statistically patients have a higher chance of being in a motor vehicle accident than having a serious anesthetic problem or death.  Obviously there are risks of undergoing any type of anesthesia and all cosmetic surgery and anesthesia patients must be thoroughly evaluated by a doctor prior to having anesthesia.  Smoking, obesity, diseases and allergies can all put patients at increased risk for anesthesia.  Fortunately, most patients desiring cosmetic surgery are  usually healthy enough to undergo some type of anesthesia.  For those whom aren’t, staying alive is a better option than looking better.

If you are considering cosmetic surgery discussion your anesthesia with your surgeon is an important part of the informed consent process and should be given serious consideration by all patients. It is important to know what type of anesthesia you will be getting and who will be administering it.  Some surgeons are trained and experienced in ambulatory outpatient office anesthesia and along with their staff provide the anesthesia and surgery.  It is important that in this situation, the doctor’s office has the same level of monitoring, emergency drugs and devices as a hospital.  For more complex anesthetic or medically compromised patients, nurse anesthetists or physician anesthesiologists usually provide anesthetic care.

To find out more about cosmetic facial surgery by Dr. Joe Niamtu in Richmond, Virginia visit www.lovethatface.com.

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

www.lovethatface.com

Blind Lady Gets Facelift!

 

 Although this sounds like a headline from the National Enquirer, it is actually a true story about a very courageous woman who is an inspiration to all of us.  As part of my blog, I enjoy sharing interesting or unusual patient profiles with my readers.  All surgeons are humans and sometimes don’t get much credit for the personal side of life.  Sometimes the public brands us a scalpel wielding machines without other interests.  This is what led me to include “patient profiles” as an occasional blog topic.

One day, several years ago, I was preparing to enter the consultation room and I could tell by the body language of my staff that something unusual awaited me.  I inquired “what is going on” and was told “you will see”.  When I entered the room, knowing this was a facelift consult, I was a bit taken back to see a visually impaired person with dark glasses and a Seeing Eye dog.  A million things ran through my mind at once.  “Was this a joke?”; “Was the patient in the wrong office?” “Was my staff behind this?”  I introduced myself like I always do and shook the patient’s hand.  “What can I help you with today?” I asked.  “I am here to discuss having a facelift” answered the petite lady in sunglasses while her dog wagged his tail as if to approve of my presence.  This was my first conversation with Susan Dunham, who would make a life lasting impression on me and my staff that day.

Susan began a rather long story about an abusive father that frequently reminded her that she was “ugly”.  It bothered him so much, she explained, that he took her to a surgeon for a chin implant in her early years.  She went on to describe a pretty tough life with an abusive and failed marriage and then contracting a disease that robbed her of her vision.  Susan is a survivor!  She pretty much has prevailed under adversity where most of us would have failed and given up.  She described her disability as “not a big deal” and did not feel that she was missing anything.  She basically just started her life over.  Susan told me that she was dieting and working out daily at a local gym.  She told me that she is young and wants to date and despite her healthy regimen, she can feel herself aging.  She went on to say how much she wanted to do a facelift but she cannot secure employment of her talents and can barely get by with the expenses of life and raising her children.  She said that getting cosmetic facial surgery was basically a dream and she knew she could not ever afford it.  This was a pretty emotional conversation for both of us.

My staff and I were pretty captivated with this brave person and it was my pleasure, I told her, to perform her facelift on a pro bono basis.  Susan was pretty taken back that a stranger would do thousands of dollars of surgery for free.  We told her it was our honor and pleasure.  It was also a week before Christmas and it was probably the best gift I would ever give.

Fast forward to surgery day.  Susan and “Puppy” (we are not allowed to know the dog’s name as calling him by name would be a working distraction.  The dog has a sign on his collar “don’t pet me, I am working”) presented bright eyed and bushy tailed (especially Puppy).  Although Susan and Puppy are constant companions, he was denied entry to the operating room and waited somewhat nervously throughout the surgery.  Whoever said a dog was man’s best friend was spot on!  After several hours of surgery Susan was wheeled out of the operating suite and Puppy accompanied her to the recovery room.  Surgery center or not, we could not restrain Puppy from joining Susan in bed.

Susan and Puppy in Bed

Susan did pretty well postoperatively but called me the night before Christmas Eve stating that she was bleeding from one side of her surgery.  My wife and I were on our way to a black tie event and were diverted to Susan’s home.  Darn it!  She was bleeding under her facelift flap and I did not want it to progress.  Since Susan obviously does not drive, I loaded her and Puppy into my car, dropped my wife off at the party, and found a few staff members that met us at the office.  We opened the stitches and controlled the area of bleeding and I was finished just in time to pick my wife up after the party.  These things happen.

Susan went on to heal uneventfully and was soon back at the gym, grocery store and walking her dog.  Her friends were quick to notice her new look and the local newspaper also took notice and wrote a nice article about her experience.  Click below to view the article in PDF format.

 

 blind-lady-gets-facelift 

Somehow, and probably to the power of the Internet, Susan was contacted by the Sunday Magazine from the London Times who also wrote a very nice article about Susan. 

Susan gets som international press

 Susan visits on a regular basis, and we have plumped her lips and done a few other minor procedures on her.  She is simply a joy to be around and has been an inspiring force in our lives.  Funny where cosmetic surgery can lead. 

To find out more about Dr. Niamtu and  cosmetic facial in Richmond, Virginia visit www.lovethatface.com

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

www.lovethatface.com

Only Use A Board Certified Plastic Surgeon??

 

It seems that cosmetic surgery is one of the most popular topics to read about these days.  Pick up any magazine or paper and you will likely find an article on cosmetic facial surgery.  Same goes for TV and radio; cosmetic surgery is a popular topic.

We all know that there are a lot of different types of surgeons (and nonsurgeons) that perform cosmetic surgery.  We all know that some of these docs are really good and others may not be so good.  We also know that because of all of the many specialties that do cosmetic surgery that there is also a lot of competition among these groups.  Knowing all of the above, the question frequently arises on how to pick a competent surgeon.  Unfortunately, too often, you will read “only have cosmetic surgery from a board certified plastic surgeon”.  Let’s think about this for a minute.  It is like saying only buy a Lexus because it is the best car and all other cars are unsafe.  We know that there are many safe cars and if one company says that theirs is the best, it does not mean that all other car companies are no good.  With the transparency of this marketing hype it makes one wonder how the “only board certified plastic surgery thing” continue to be stated?  It is obvious that it is false marketing by the plastic surgery organization.  There is nothing wrong with them cheering for their team, but it is an opinion of their society, not a fact. I use the word false because there are not studies to support that ANY specialty of surgeon has better outcomes, happier patients, or fewer complications than another.  80% of cosmetic surgery is performed by non-plastic surgeons. Any organization or group can make statements to fool the public into thinking they are the best or the only choice.  This is exactly what organized plastic surgery has done.  I have many plastic surgery friends and colleagues and some of them received excellent training in cosmetic surgery and have great results.  Others plastic surgery friends, received very little cosmetic training as plastic surgery is not cosmetic surgery so they spent their training learning about burns, reconstruction and other important procedures, but not cosmetic surgery.  I have seen many outcomes from these people where the outcomes were not so great. It as a fallacy to think that plastic surgery is cosmetic surgery or that all plastic surgeons are good cosmetic surgeons.  Simply not true.  I have had numerous patients that came to my office because bought the hype of “only see a board certified plastic surgeon, and when they went there for treatment, it was done by a nurse!!  Not that there are not competent nurses, but doesn’t that contradict the mantra?

A recent in the Journal of Plastic and Reconsructive Surgery concluded that “Senior Residents (in Plastic Surery) felt deficient in facial cosmetic training” (see image below).  The article goes on to describe the average minimum cosmetic surgery case requiements for plastic surgery programs is 7 facelifts, 8 eyelid surgeries, six nose surgeires and 10 breast implants (see image below).  Obvisously, some residents get more training but the fact is that entering private practice with the experience of 7 facelifts or 8 eyelid surgeries does not make someone an expert or better than other specialties.  Again, just because someone is a plastic surgeon does no make them better than another specialty.

click on above to enlarge

click on above to enlarge

There are numerous specialties other than plastic surgery that perform safe and effective cosmetic surgery.  These include dermatologists, oral and maxillofacial surgeons, ENT’s, ophthalmologists as well as other specialties.  Given my personal training as an example, I have spent 10 years after college learning about the head and neck.  My expertise is in head and neck surgery and I understand the face and have had as much (if not more) experience in facial surgery as any specialty that exists.  I am also board certified in my specialty (oral and maxillofacial surgery) and limit my practice to cosmetic facial surgery.  Having said this, does it make more sense to have a facelift from a board certified oral and maxillofacial surgeon that only does faces or a board certified plastic surgeon that may do a handful of facelifts a year, but performs hundreds of body procedures?  I performed over 80 facelifts last year while the average plastic surgeon performs 26.

This blog entry is not meant to discredit plastic surgery as it is an impressive specialty with many talented surgeons and I am friends with many of them.  The only purpose of this discussion is to dispel the self-serving notion that patients should “only have plastic surgery from a board certified plastic surgeon” .  This in untrue, unfounded, is not proven and only serves to fool the public.  Who is a cosmetic surgeon?  A cosmetic surgeon is a surgeon that limits his or her practice to cosmetic surgery.  It does not signify a specific specialty. 

What is most important here is the success of any surgeon from any specialty.  That is measured very easily by looking for cosmetic surgeons with good outcomes, low complications, happy patients and a booming and successful practice.  Looking for the aforementioned traits is a much better indicator for a good doc than buying into specialty marketing propaganda.

To find out more about Dr. Niamtu and Cosmetic Facial Surgery in Richmond, Virginia visit www.lovethatface.com

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

www.lovethatface.com