At Thomassen Plastic Surgery, patient comfort and safety are at the heart of every procedure. Over the past two decades, there’s been a growing demand for in-office aesthetic and reconstructive procedures—allowing patients to achieve transformative results without the need for general anesthesia or hospital admission.
With modern anesthesia techniques and advanced monitoring, many cosmetic surgeries—such as eyelid surgery, facelifts, fat grafting, and reconstruction—can now be safely performed in an office setting.
In this article, we explain the types of anesthesia used in plastic surgery, their benefits, and what to expect from each option, so you can feel confident and informed ahead of your procedure.
🧊 Non-Anesthetic Comfort Measures
Even before anesthesia, several comfort strategies are used to minimize discomfort from injections and numbing medications.
Cooling and Ice
Cold application devices or ice packs help numb the area before injections. Cooling causes gentle vasoconstriction, which reduces bruising, swelling, and pain. Studies show that patients who received cooling reported up to 70% less pain during injection-based treatments like dermal fillers.
Distraction Techniques
Simple distraction—such as conversation, videos, or soft tapping—can reduce perceived pain. Vibratory devices placed near the treatment site are especially effective: by stimulating certain nerve fibers, they “close the gate” to pain signals reaching the brain, making injections more tolerable.
💉 Local Anesthesia
Local anesthesia is the most common option for in-office plastic surgery. It numbs a specific area so you remain awake but comfortable.
How It Works
Local anesthetics—like lidocaine or bupivacaine—temporarily block nerve signals by interrupting sodium channel activity.
This prevents pain signals from traveling to the brain.
Common Uses
- Eyelid surgery (blepharoplasty)
- Skin lesion removal or reconstruction
- Otoplasty (ear reshaping)
- Scar revision or small excisions
Benefits
- Fast onset (2–5 minutes with lidocaine)
- Minimal downtime
- No IV line or general anesthesia needed
- You remain awake and responsive
Lidocaine vs. Bupivacaine
| Anesthetic | Onset | Duration | Notes |
|---|---|---|---|
| Lidocaine | 2–5 min | 2–4 hrs | Quick numbing, short recovery |
| Bupivacaine | 5–10 min | 4–8 hrs | Longer pain relief post-op |
Safe Dosing
Local anesthetics are dosed carefully based on body weight. Adding epinephrine helps reduce bleeding, prolongs the numbing effect, and decreases systemic absorption—making procedures safer and cleaner.
| Agent | Max Dose (mg/kg) w/ Epinephrine | Without Epinephrine |
|---|---|---|
| Lidocaine | 7.0 | 4.5 |
| Bupivacaine | 2.5 | 2.0 |
| Mepivacaine | 7.0 | 4.5 |
| Ropivacaine | 3.0 | 3.0 |
To reduce injection discomfort, our team often buffers lidocaine with sodium bicarbonate, neutralizing its acidity for a smoother, sting-free experience.
🧠 Nerve Blocks
For procedures on larger areas of the face—like the forehead, lips, or nose—Dr. Thomassen may use facial nerve blocks to provide deep, localized anesthesia with minimal tissue swelling.
Common nerve blocks include:
- Supraorbital & Supratrochlear — forehead and brow area
- Infraorbital — cheeks, upper lip, and midface
- Mental nerve — chin and lower lip
- Nasal block — nose and midface surgery
Nerve blocks can last several hours and often reduce the need for additional anesthesia.
😌 Noninvasive Sedation and Relaxation Options
For patients who experience anxiety before or during surgery, mild sedation can help you relax without losing consciousness.
Oral Sedation
Oral benzodiazepines such as diazepam (Valium) or lorazepam (Ativan) are often used for relaxation. These medications:
- Decrease anxiety
- Promote calmness and mild drowsiness
- Provide light amnesia (so you remember less of the procedure)
Your regimen is personalized to your health status and anxiety level. For most patients, oral sedation is paired with local anesthesia for comfort.
Nitrous Oxide (“Laughing Gas”)
Nitrous oxide, or Pro-Nox, is a self-administered gas mixture that provides fast-acting relaxation and mild pain relief.
Benefits include:
- Takes effect within seconds
- Wears off quickly after stopping
- You stay awake and responsive
- Safe, with minimal risk of respiratory depression
Nitrous oxide is commonly used for filler injections, laser treatments, and minor in-office surgeries.
💧 Intravenous (IV) Sedation
When deeper relaxation or longer procedures are planned, IV anesthesia offers a balance between comfort and consciousness.
Moderate Sedation
A combination of midazolam (Versed) and fentanyl provides relaxation, pain relief, and light sleep while you remain responsive.
It’s ideal for procedures such as:
- Facelifts
- Lower lid blepharoplasties
- Fat grafting
Patients typically describe this as “twilight sleep”—you may not recall much of the procedure, but your vital signs and breathing remain stable throughout.
Deep Sedation (TIVA)
For more complex surgeries, Total Intravenous Anesthesia (TIVA) uses propofol—a fast-acting medication that induces a deeper level of sleep without full intubation.
Performed under the supervision of a certified anesthetist, TIVA offers:
- Smooth, quick recovery
- Minimal nausea or grogginess
- Excellent control of blood pressure and comfort
- Reduced risks compared to general anesthesia
TIVA is frequently combined with local anesthesia for optimal results and faster recovery.
🛌 General Anesthesia (GA)
What it is
General anesthesia places you in a controlled, fully asleep state so you feel no pain, have no awareness, and don’t move during surgery. Breathing is supported with a laryngeal mask airway (LMA) or an endotracheal tube (ETT), depending on your anatomy and the procedure.
When Dr. Thomassen Recommends GA
- When medical history or airway considerations make GA the safest route
- Advanced Rhinoplasty procedures to protect the airway
How We Keep You Safe
- Board-certified anesthesia professionals in an accredited surgical suite
- Continuous monitoring: ECG, blood pressure, oxygen saturation, capnography, temperature
- Active warming to prevent hypothermia, plus careful positioning & padding to protect nerves/skin
- DVT prevention with compression devices for longer cases
- Enhanced-recovery protocols to reduce nausea and speed wake-up
Medications & Airway
- Induction with fast-acting IV agents (commonly propofol), then maintenance with either IV infusions or modern inhaled agents
- Airway secured with an LMA (less throat irritation, faster wake-up) or ETT (needed for some procedures/positions). We choose the least invasive device that still gives maximum safety.
Nausea Prevention & Comfort
- Multi-modal antiemetics (e.g., ondansetron + dexamethasone, and others when indicated)
- Opioid-sparing pain control (local anesthetics, acetaminophen, COX-2/NSAID options when appropriate)
- Local/nerve blocks during surgery to lower pain and reduce the need for stronger medications afterward
OSA (Sleep Apnea) & Special Situations
- We use short-acting drugs, head-up recovery position, and a narcotic-sparing plan
- Bring your CPAP on surgery day; some patients need extended monitoring before discharge
What You’ll Experience
- Pre-op: Final checks, IV started, warm blankets; you’ll review the plan one more time.
- Asleep: You drift off within seconds; we manage everything and continuously monitor you.
- Wake-up: Most patients awaken within minutes; you’ll be comfortable, monitored, and given sips of liquids when safe.
- Going Home: Once alert, walking with help, and comfortable, you’ll go home with a trusted adult. Typical PACU time: 1–2 hours (varies by case).
Pros
- No awareness or memory of surgery
- Ideal for long/complex operations
- Complete control of the airway and surgical conditions
Considerations
- Slightly higher chance of post-op nausea (we proactively prevent and treat it)
- Sore throat or hoarseness can occur (more common with ETT than LMA)
- You’ll need a responsible adult to drive you home and stay with you the first night
Is General Anesthesia Safe?
In healthy, properly selected patients in an accredited setting, yes. Today’s short-acting medications, continuous monitoring, and our enhanced-recovery protocols make GA very safe and highly customizable. Your plan is always individualized to your ASA status, medical history, procedure length, and comfort goals.
🩺 Safety First: The Thomassen Approach
At Thomassen Plastic Surgery, your safety is our top priority. Every anesthesia plan is customized based on:
- Your medical history and ASA classification
- The type and duration of your procedure
- Your comfort level and recovery goals
All procedures are performed in a fully accredited surgical suite with state-of-the-art monitoring, emergency equipment, and trained personnel.
Our collaborative approach—between Dr. Thomassen, certified nurse anesthetists, and surgical nurses—ensures precision, safety, and peace of mind throughout your surgical journey.
✅ Summary: Choosing the Right Anesthesia
| Procedure | Typical Anesthesia | Awake? | Recovery Time |
|---|---|---|---|
| Botox / Fillers / Peels | Cooling, topical, or vibration | ✔ | Immediate |
| Upper Eyelid surgery | Local ± oral sedation | ✔ | Same day |
| Facelift / Neck lift | Local + IV sedation | Partial | 1–2 hours |
| Rhinoplasty | General | ✖ | 1–2 hours |
| Skin lesion removal | Local | ✔ | Minimal |
Conclusion
Modern anesthesia techniques have revolutionized cosmetic surgery, allowing for safer, more comfortable, and faster recovery experiences. Whether you’re having a minimally invasive filler or a full facelift, Dr. John Thomassen and his team customize anesthesia to your needs—maximizing comfort while minimizing risk.
If you’re considering facial rejuvenation or body contouring, schedule a consultation at Thomassen Plastic Surgery to discuss your anesthesia options and personalized surgical plan.