Types of Anaesthesia Used in Plastic Surgery
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Anaesthesia is one of the parts of cosmetic surgery that patients worry about most and understand least. The honest position is that modern anaesthesia is one of the safest interventions in medicine, that the techniques used at properly regulated UK clinics have a very strong safety record, and that the right anaesthetic for a given procedure depends on factors the anaesthetist assesses with you in detail at the pre-operative meeting. This guide explains the main types of anaesthesia used in cosmetic surgery, when each is appropriate, what the experience of each is actually like, and how Centre for Surgery’s approach — built around TIVA (total intravenous anaesthesia) for the majority of our work — differs from the older gas-based techniques some clinics still rely on.
The three main types of anaesthesia
Cosmetic procedures use one of three broad approaches, sometimes in combination:
Local anaesthesia. A specific area of tissue is numbed by injecting a local anaesthetic (lidocaine, bupivacaine, or a combination). The patient remains fully awake and aware. Suitable for small, localised procedures — minor mole excisions, small skin lesion removals, some intimate procedures, and certain ear procedures.
Local anaesthesia with sedation. Local anaesthetic is combined with intravenous sedative medication, which makes the patient drowsy or lightly asleep but not fully unconscious. The patient breathes for themselves throughout. Used for moderate procedures — some labiaplasty cases, some otoplasty procedures, smaller revision work, and selected facial work.
General anaesthesia. The patient is rendered fully unconscious with no awareness of the procedure. Within general anaesthesia there are two main subtypes used in cosmetic surgery:
Why TIVA is the standard at Centre for Surgery
For the majority of our cosmetic surgery — facelift, rhinoplasty, blepharoplasty, breast surgery, abdominoplasty, body contouring — we use TIVA rather than traditional gas-based general anaesthesia. The advantages are clinically meaningful:
For most patients, the practical experience of TIVA is: a smooth propofol induction in under a minute, the procedure itself with no awareness, and waking up alert and comfortable with minimal nausea. Patients who have had previous gas-based anaesthesia frequently report TIVA as a markedly better experience.
How the anaesthetic is chosen for your procedure
The anaesthetic plan is tailored to the procedure, patient health, anticipated operating time, and individual preferences. Common patterns:
Local anaesthesia alone for:
Local with sedation for:
TIVA general anaesthesia for:
The anaesthetist will discuss the planned approach with you at the pre-operative meeting and answer any questions specific to your situation.
Local anaesthesia in detail
Local anaesthetic injection takes effect within minutes and provides full pain relief in the treated area for 2-12 hours depending on the agent used. Lidocaine acts quickly with a 2-4 hour duration; bupivacaine takes longer to take effect but lasts 6-12 hours and is often used for post-operative pain relief in larger procedures.
What the experience is like:
Local anaesthesia avoids the time and complexity of general anaesthesia and is the safest option where the procedure is small enough to tolerate. The limitation is that it does not address anxiety, body movement, or larger areas where the volume of local anaesthetic would itself become a concern.
Local with sedation in detail
Combining local anaesthetic with intravenous sedation produces an experience that sits between fully awake and fully anaesthetised. Sedative agents (typically midazolam, propofol, or a combination) are titrated to keep the patient drowsy and relaxed but breathing independently.
What the experience is like:
This approach is particularly useful for patients who are anxious about being fully awake during a procedure but for whom full general anaesthesia would be unnecessarily heavy-handed.
General anaesthesia (TIVA) in detail
Full general anaesthesia produces complete unconsciousness, with the anaesthetist managing the patient’s breathing and physiology throughout the procedure. With TIVA specifically, the entire anaesthetic is delivered intravenously using continuously running infusions.
What the experience is like:
Safety of modern anaesthesia
The safety record of modern anaesthesia in healthy adults undergoing elective surgery is among the strongest in medicine. The risk of death directly attributable to anaesthesia in a healthy adult is approximately 1 in 200, ,000 — substantially lower than the risk of dying in a road traffic accident in any given year.
Several factors contribute to this safety record:
Common side effects and how they are managed
Even with the safest anaesthesia, some minor side effects are common:
Post-operative nausea and vomiting (PONV) — substantially reduced with TIVA compared with gas-based anaesthesia. Patients at higher risk (motion sickness history, previous PONV, female, non-smoker) are given prophylactic anti-emetic medication. Most patients have no nausea at all with modern protocols.
Sore throat — caused by airway device placement. Usually mild and resolves within hours. More common with endotracheal tubes than with LMAs.
Drowsiness and disorientation on emergence — much shorter with TIVA than with gas anaesthesia. Most patients are clear-headed within 1-2 hours.
Headache — usually related to fasting and dehydration rather than the anaesthetic itself. Resolves with hydration.
Shivering — common in the immediate post-operative period as the body’s temperature regulation returns to normal. Managed with warming blankets and resolves quickly.
Bruising or tenderness at the cannulation site — minor and self-limiting.
Difficulty urinating — occasionally seen, particularly after longer procedures. Almost always self-resolving.
Rare but serious risks
The serious risks of general anaesthesia are rare but should be discussed at pre-operative assessment:
Pre-operative preparation for anaesthesia
What you can do to make your anaesthesia as safe and smooth as possible:
Honest pre-operative assessment. Disclose all medications (including supplements, herbal remedies, recreational drugs, hormonal contraception, and GLP-1 weight loss medications), all known allergies, all medical conditions however minor, and any previous anaesthetic complications.
Fasting. Follow the fasting instructions exactly. The usual guidance is no food for 6 hours before surgery and clear fluids only up to 2 hours before. Cheating on fasting is a real safety issue, not a formality.
Medication management. Some medications should be continued (most cardiac medications, anti-epileptics, asthma inhalers); others should be stopped (anticoagulants, some diabetes medications, GLP-1 Weight Loss Medication loss medications). You will be given specific written guidance.
Smoking and vaping cessation. Stop completely for 4-6 weeks pre-operatively. See smoking and cosmetic surgery and vaping and cosmetic surgery.
Alcohol moderation. Reduce alcohol intake in the weeks before surgery. Abstain completely for 48 hours before.
Respiratory health. Postpone surgery if you develop a cold, flu, or chest infection in the days before. See cosmetic surgery with a cold.
Hydration and nutrition. Aim for normal hydration and nutrition in the days before; this reduces the risk of headache and dizziness post-operatively.
Transport home. Arrange a responsible adult to collect you and stay with you for the first 24 hours after general anaesthesia.
The post-anaesthesia recovery
What to expect after general anaesthesia (TIVA):
FAQs
Is general anaesthesia safe? In healthy adults having elective surgery, very safe. The risk of serious anaesthetic complication is low and substantially lower than the risk of many everyday activities.
What is TIVA and is it better than gas anaesthesia? TIVA is total intravenous anaesthesia, delivered entirely via continuous IV infusion of propofol. It produces less post-operative nausea, smoother emergence, and better physiological stability than gas-based anaesthesia. It is our standard approach for most cosmetic surgery. See TIVA for cosmetic surgery.
Will I wake up during my surgery? Awareness under modern general anaesthesia is extremely rare. Depth-of-anaesthesia monitoring during your procedure makes it rarer still.
Can I choose local rather than general anaesthesia? For some procedures, yes — discuss preferences at pre-operative assessment. For procedures that genuinely need full general anaesthesia, local would not be appropriate.
How long does the anaesthetic take to wear off? The acute effects clear within 1-2 hours of TIVA general anaesthesia. Full elimination from the body takes up to a week, though most subjective effects resolve within hours.
Will I feel sick after surgery? Much less likely with TIVA than with older anaesthetic techniques. Anti-emetic prophylaxis further reduces the risk. Most patients have no significant nausea.
What if I have had a bad reaction to anaesthesia before? Disclose this at pre-operative assessment. The anaesthetic plan can be adjusted to avoid the agents involved and add specific protective measures.
Booking a consultation
If you are considering cosmetic surgery and want to discuss the anaesthetic approach for your specific procedure, this can be covered at the surgical consultation and explored further at the pre-operative anaesthetic meeting. Call or use the contact form to arrange a consultation at our Baker Street clinic.
Centre for Surgery · CQC-regulated · GMC specialist-registered surgeons · 95–97 Baker Street, Marylebone, London W1U 6RN · · Book a consultation · Finance from 0% APR
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Centre for Surgery is a CQC-regulated private hospital on London’s Baker Street, delivering plastic and cosmetic surgery through GMC-registered specialist surgeons. Our expertise spans facial procedures including rhinoplasty and facelift surgery, breast surgery, gynaecomastia surgery for men, and body contouring procedures such as liposuction and tummy tuck surgery. Patient safety, surgical excellence and natural-looking results sit at the heart of everything we do.
Centre for Surgery is a CQC-regulated private hospital on London’s iconic Baker Street, offering plastic and cosmetic surgery led by GMC-registered consultant surgeons.
95-97 Baker Street
Marylebone
London
W1U 6RN
Mon – Sat, 9am – 6pm
Saturday consultations available
