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Twilight vs. General Anesthesia

If you’re considering investing in a cosmetic procedure but are turned off by the risks associated with general anesthesia, there’s an alternative you may want to consider: twilight anesthesia.

Twilight anesthesia puts the patient in a state of conscious sedation through mild doses of medication, providing induced hypnosis, anxiety relief, and the inability to form new memories. Often administered in dental procedures, the approach is quickly gaining popularity among plastic surgeons as well, with many common cosmetic procedures now performed safely under twilight anesthesia.

Also known as twilight sleep, twilight anesthesia is achieved by administering patients with mild doses of medications such as fentanyl, valium, midazolam, propofol, ketamine and nitrous oxide (laughing gas).

When in twilight sleep, the patient is conscious and responsive, but also relaxed and sleepy. The benefits are immeasurable, especially for patients who are unsure about the deep state of unconsciousness that comes with general anesthetic techniques.

The Four Levels of Anesthesia

Sedation is commonly achieved in four levels, starting with minimal sedation where a patient is able to respond to verbal commands but may experience some impaired cognition and coordination.

During level one of anesthesia, the heart and lungs are unaffected. Levels two and three of anesthesia (moderate sedation/analgesia and deep sedation/analgesia, respectively) require a drug-induced depression of consciousness. Twilight anesthesia is level two of sedation by anesthesia.

The primary difference between these levels is that in level two breathing tubes are not required, whereas they are in level three. In other words, twilight anesthesia is the highest level of sedation that doesn’t require breathing tubes.

The final level of anesthesia, level four, combines general anesthesia with spinal or major regional anesthesia. The ventilator and cardiovascular functions of the body may also be impaired at this level.

General Anesthesia Vs. Twilight Anesthesia

The main difference between general and twilight anesthesia is the level of consciousness experienced by the patient.

The goal of general anesthesia is to render the patient completely unconscious, consequently unable to control their reflexes and autonomic nervous system, whereas twilight anesthesia allows patients to remain in control of their responses and reflexes.

Additionally, when under general anesthesia, patients are often required to breathe with the help of a breathing tube and can experience a myriad of side effects ranging from nausea to high blood pressure and changes in heart rate.

Compared to traditional anesthesia, the twilight state of moderate sedation offers a quicker recovery time, coupled with the reduced likelihood of side effects or complications occurring. Also, because it requires fewer anesthesia medications and supplies, it’s often less expensive than traditional anesthetic techniques.

In both instances, during surgery your doctor will monitor oxygen levels using a pulse oximeter or similar device to measure vital signs and make sure you don’t experience any immediate complications associated with the chosen technique.

To determine which option is best for you, you’ll need to have an in-depth conversation about your concerns, health risks and preferences with your surgeon and anesthesiologist. There are several side effects of twilight anesthesia to consider as well, including nausea, vomiting, amnesia, and a slowed heart rate, but these are generally less intense than with general anesthesia.

Other Ways to Avoid General Anesthesia

Twilight sedation and general anesthesia aren’t the only options available for patients seeking a quicker recovery period and decreased risk during cosmetic surgery.

“Awake” plastic surgery may be an option for minor surgery, especially facelifts. This technique only requires local anesthesia around the area being treated, and doesn’t put the patient in a state of deep sedation or sleep. The type of anesthetic agent used during routine dental work like cavity fillings is typically considered local anesthesia or local analgesia.

Your local anesthetic professional and plastic surgeon may caution against undergoing more intensive plastic surgery and/or other medical procedures while awake. The drug-induced states of general and twilight anesthesia techniques ensure that the muscles stay relaxed during surgery, while simultaneously providing the definite advantage of allowing patients to awaken with no recollection of the experience.

Depending on your health record, your doctor may prefer a combination of local anesthesia and twilight anesthesia or general anesthesia.

Procedures Done Under Twilight Anesthesia

Twilight Anesthesia

Although there are many plastic surgeons and medical professionals offering twilight sedation for a wide range of cosmetic procedures, the following are among the most common.

  • Breast Augmentation — Although it may seem counterintuitive, minimal sedation is actually a possibility during breast augmentation. Doctors may prefer to perform this procedure safely using regional anesthesia via intravenous medications (twilight sleep) or general anesthesia. With that being said, the majority of plastic surgeons caution against using twilight anesthesia for breast reduction surgeries.
  • BlepharoplastyEyelid surgery, medically known as blepharoplasty, is performed to alter the appearance of the eyelids and/or improve vision. Blepharoplasty is often recommended under twilight sedation because it ensures fewer side effects and less recovery time.
  • Chin Implant — Chin implants can be performed under local, twilight or general anesthesia. However, the procedure is most often conducted using only local anesthesia and oral sedation. That being said, patients who prefer a higher level of conscious sedation can request twilight anesthesia.
  • Facelift — Some of the most common candidates for twilight anesthesia are facelift patients. Modern facelifts are similar to chin implants in that they can be performed under local anesthesia and sedatives, while a twilight state is a good option for those with a lower tolerance for pain and discomfort.
  • Laser Resurfacing — Thankfully, one of the most popular cosmetic skin procedures is safely performed under twilight anesthesia. This method of smoothing facial wrinkles and skin irregularities can be performed with local anesthesia, twilight anesthesia or a combination of the two.
  • Liposuction — Many common fat-removal surgeries, including liposuction and tummy tucks, are safely performed using sedative drugs to induce a twilight state. Some doctors caution against twilight sedation for a combination of the two procedures, however, since a high level of muscle relaxation is required for success.
  • Gummy Smile Correction — If you’re self-conscious about your gummy smile, then you’re in luck: this procedure — which is designed to eliminate the appearance of overexposed gums or small teeth — is commonly performed under mild twilight sedation.
  • Brazilian Butt Lift — Not all plastic surgeons would recommend twilight sedation for extensive procedures like Brazilian butt lifts or butt implants, but it is possible. As long as you express your concern about undergoing general anesthesia for this procedure, your doctor and anesthesiologist will be able to work with you to create the ideal anesthesia plan.
  • Labiaplasty — Although labiaplasty, which reduces excess tissue surrounding the labia, is considered a highly delicate cosmetic procedure, it can still be conducted with local and twilight anesthesia. In fact, many plastic surgeries recommend undergoing this procedure using one of these two anesthesia techniques.
  • Brow Lift — Brow lifts are relatively non-extensive cosmetic procedures that take between one and two hours to complete. Because of this, they are generally performed under twilight anesthesia or IV sedation. Additionally, the relatively non-invasive nature of the brow lift makes it easy to customize to your anesthesia preferences. It can be performed under local, twilight or general anesthesia.

Developing the right anesthesia plan comes down to finding a good plastic surgeon who’s willing to work with you to ensure you’re comfortable throughout the entire surgical/recovery process.

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