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Our Approach: Anesthesia

LOCAL ANESTHESIA (see below »)
Alone is used for minor or touch up procedures only.

A recent New York Times article featured non-plastic surgeons who were promoting Breast Augmentation » under local anesthesia only In their offices. While this surgery can be done with local only, it can be a very uncomfortable and unpleasant experience. On the other hand, local anesthesia when carefully administered and monitored twilight sleep is both comfortable and safe. Type of anesthesia to use is but one of many factors to be considered when contemplating this surgery, it should not be the primary one.

In fact, this is the reason it is not a generally accepted practice, especially since the addition of intravenous sedation monitored by an anesthesia professional is both comfortable and safe. Most surgeons who advocate local anesthesia for major cosmetic procedures lack accredited facilities and hospital privileges for these procedures.

More about Cosmetic Surgery with Only Local Anesthesia »

Local anesthesia (see below ») when provided by a CRNA (Certified Registered Nurse Anesthetist) or an Anesthesiologist is our preference for many procedures, since we have had extensive and successive experience with this anesthetic approach.
In our opinion:

    • Is safer than a general anesthetic
    • Minimizes post-operative recovery, as well as, nausea and vomiting
    • Is less stressful on patient
    • Requires no breathing tube; therefore, no resulting sore throat
    • Reduces cost by using office facility
    • Twilight Sleep may be used for

This technique produces complete loss of consciousness and, therefore, the complete loss of the perception of pain.

Anesthetic agents are administered intravenously or by inhalation (gas) by an anesthesiologist or CRNA.

  • Procedures requiring general anesthesia are done at an appropriate facility: a surgical hospital.
  • Most procedures can be carried out in our office surgical facility, which is accredited for IV sedation or twilight sleep (AAAAFS). In fact, our extensive experience with local anesthesia and twilight sleep allow us to perform most of our surgery safely and effectively.
  • In any surgery, the choice of anesthesia ultimately rests with the surgeon; however, it is our belief that a well-informed patient can understand and participate in this important decision.


Mahlon Forman, CRNA, has been administering anesthesia for the surgeons of North Dallas Plastic Surgery Associates since 1996. Prior to that time her experience focused on anesthesia for trauma and for cosmetic surgery in New York City and Fort Worth.

Mahlon has been practicing since June of 1980 when she qualified on the national board exams and continues to be re-certified every two years by the National Board for Recertification of Nurse Anesthetists. She is also certified by the American Heart Association in Advanced Cardiac Life Support. Mahlon currently specializes in intravenous sedation with monitored care, which demands not only a knowledge of the science of anesthesia, but an aptitude for the art of anesthesia. Her philosophy stresses patient care, communication, and vigilance.

Anesthesia: Gain Without Pain!
Cosmetic Surgery: Promises and Pitfalls™


Modern surgery can be performed painlessly by using current, safe and effective anesthesia methods. “No pain, no gain” may be applicable to exercise, but not to surgery.


Type of anesthesia used depends on several factors:

  • Procedure - location, extent, etc.
  • Surgeon - preference based on training, experience and judgment
  • Patient - choice may be influenced by previous experience of self or other
  • Anesthesia provider preference

Ultimate decision by the surgeon may be made in conjunction with patient preference. Patient comfort and safety should be the major factors in this decision. Modern anesthesia techniques are safe, but require:

  • Qualified and competent anesthesia providers
  • State-of-the-art anesthesia, resuscitation and monitoring equipment
  • Preoperative evaluation and preparation of patients
  • Appropriate choice of anesthesia technique for surgical procedure, surgeon and patient

Accredited surgical facility (See our thoughts here - Promises and Pitfalls: Office Surgery » .)



A local anesthetic agent (Novocain, Xylocaine, Marcaine, etc.) is introduced into the tissues (injected). This technique provides a profound numbness that allows selective surgical procedures to be carried out with no discomfort in an awake patient.

Read more about Plastic Surgery with Only Local Anesthesia »: Can it be as safe and comfortable?


In this technique, relaxing drugs are administered into a vein. The medications are used in appropriate doses to provide anxiety relief, amnesia for the surgery and a light sleep.

However, patient’s normal reflexes are maintained during the entire anesthetic period; in other words, at all times, the patient is able to breath without assistance, has a normal gag reflex, which is protective should unexpected vomiting occur, etc.

  • It is NOT intended to provide relief of surgical pain, which is the purpose of the local, dilute local infiltration or regional anesthetic that is used in conjunction with the IV sedation.
  • If IV sedation produces complete loss of consciousness, then it is actually a general anesthetic (because this is the definition of general anesthesia). This situation is to be avoided.
  • IV sedation is usually provided by an anesthesiologist or CRNA.
  • Careful monitoring of the patient’s vital signs ensures patient safety.
  • It requires only a limited recovery period.
  • It usually is associated with less nausea and vomiting than general anesthesia.
  • It avoids the added risk of a general anesthetic.


This anesthetic technique produces complete loss of consciousness and, therefore, complete loss of the perception of pain.
Anesthetic agents are administered intravenously or by inhalation (gas) by an anesthesiologist or CRNA.

  • A breathing tube is placed in the windpipe to maintain a clear breathing passage (airway) and respirations are assisted by the anesthetist or anesthesiologist.
  • A wide range of vital signs is monitored constantly utilizing electronic (often computerized) monitoring equipment.
  • However, any general anesthetic carries certain risk, which includes blood clots (pulmonary emboli), post-operative breathing problems (pneumonia, etc.), as well as, activating preexisting health problems, including heart, lung, liver, etc.
  • A recovery period in a specially equipped recovery area is required to ensure patient safety and varies from 30 minutes to several hours.
  • Modern general anesthesia, used in a suitable setting (hospital, surgicenter, accredited office facility, etc.) and administered by a qualified anesthesiologist or nurse anesthetist, is very safe.

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More Promises and Pitfalls Information »

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