The Issues About General Anesthesia Sedation versus Local Anesthesia

Falls in Argentina photo by Dr. Robert Yoho

 We have many times emphasized in our information on our website and to our patients that we think that the light sedation that we use, which does leave the patient without any memory of the procedure, is by far the best way to go. Confusion arises with this because using pure local anesthetic the way a lot of people do, including the rapid facelift and the weekend facelift surgeons, often leaves the patients terrified and there is some pain involved. Our anesthetic, on the other hand, leaves the perception of general anesthetic, with no memory of the procedure in 99.9% of the cases, and we feel the risks are minimized and the discomfort is also minimized. Very little post anesthetic reaction occurs, with the chance of nausea, vomiting, and other bad feelings from the anesthetic being minimized.

General anesthetic is used by many well-meaning and well-trained surgeons who just haven’t found out just how to achieve good sedation without using all those heavy drugs. General sedation also requires an anesthesiologist to put the tube in the throat, and the attendant risks of general anesthesia. These surgeons generally have been trained in a hospital and are used to doing things just one way. They don’t understand and haven’t taken responsibility for the anesthesia care of their patients.

Dr. Yoho, on the other hand, as a Board-certified emergency room physician, is confident about his ability to manage patients who are sedated and his ability to give them a comfortable experience. This has been well-established after tens of thousands of cases of experience. Dr. Yoho gets as many cases as a lot of anesthesiologists get each year. We do use local anesthetic if the patient requests it as a sole or single agent for the pain relief, but we don’t usually recommend it. We recommend at least a touch of relaxation medicine and more likely our version of the single medication sedation technique that we advocate, have perfected, and have published articles in medical literature about. You can read more at DrYoho.com. You can read Dr. Yoho’s original article about this technique, which has been adopted by many surgeons across the country.

An additional advantage of your anesthesia at Dr. Yoho’s office is that you save money. Not only are the medications much less expensive than medications used for general anesthetic, but the extra expense of an anesthesiologist is avoided. Instead of an anesthesiologist, we have a fully licensed physician’s assistant who is competent to administer this medication and has been doing it for many thousands of cases. Dr. Yoho is also involved and we watch you very carefully with the standard monitoring technique that’s used in a surgery. The very cheapest of these medications, which are the Morphine/Demerol class drugs, are not used, and our technique does cost us a little more than this, but it’s much cheaper to make you comfortable using these modern medications than it is to have the anesthesiologist use a gas anesthesia or the many different drugs that are typically administered in general anesthesia.

All About The Total Makeover

Robert Yoho, MD playing with his daughter

Generally, facial procedures are done “all in one.” In other words, facelifts, eyelids, cheek implants, chin implants, noses, and laser resurfacing are often performed at the same time. This has been the traditional approach and is felt to be reasonable by the medical community. 

 However, the “total body makeover” where all this facial work is done and then breasts and liposuction are all performed together we think represents an extreme risk. One of the problems with this involves anesthesia time, which increases the problems with blood clotting and other medical issues related to the anesthesia. Surgeries over a couple of hours to us seem relatively unreasonable, although sometimes our facial surgery or breast lift will extend three hours or a little more.

So beware of the “total makeover.” We think that it’s easier for you and makes more sense to approach these things stepwise, thus getting to know the quality of your surgeon and the quality of the results bit by bit.

Am I A Surgical Candidate?

Dr. Yoho and friends in Argentina.

You are a surgical candidate if a number of things come together. First of all, you have to be psychologically ready for a surgery. Sometimes these things are stressful and sometimes they’re not, but you have to be willing to undergo the stresses of the possible complications for any of these given surgeries, however unlikely they are. Most cosmetic surgeries are comfortable and their post-operative recovery for most people is very modest, however. 

Second, you need to have good physical characteristics for the surgery that you desire. The doctor will help you understand just what kind of result you are likely to expect. For example, a woman with medium-sized breasts and a lot of breast tissue can get spectacular results with breast implants in most cases. A woman with long, skinny breasts sometimes needs reconstructive surgery and some of these surgeries come out better than others. Liposuction works very well for people with a lot of fat just under the skin surface, but doesn’t work at all for people with fat underneath the muscle wall. 

Of course, you need to be able to afford the procedure, and you need to be able to take the time off. If you are too busy to take the time off, many of the noninvasive procedures we do can, over time, make improvements that are as significant or nearly as significant as the invasive procedures. For example, our fractionated laser repeated several times can produce a fantastic result, and if you stay out of the sun and use Fallene sunscreen from drugstore.com (for example) and Retin-A over a year or two, you can get a fantastic result that rids you of wrinkles and really in many ways is as good as the invasive procedure which requires the two-week recovery and the possibility of more complications. 

Fillers can approximate a facelift for the right individual, replacing the fat and restoring the contours and form of the aging face to a younger contour, and when performed in conjunction with Botox and the resurfacing modalities, can be spectacular indeed. But the noninvasive procedures, remember, can be easily as expensive as the invasive procedures and require coming back to the office a lot.