Beverly Hills, Calif. — Using a special approach to administering local anesthetic, David Saadat, M.D., makes it possible for some patients to participate in their own surgeries.
Dr. Saadat, a clinical instructor in the division of facial plastic and reconstructive surgery, University of Southern California, Los Angeles, says he has some patients participate during such procedures as liposuction and the thread lift facelift because today's patients tend to want to be involved and feel in control.Evaluation opportunity
The other reason, which Dr. Saadat says is even more important, is that by keeping patients relatively awake during surgery, surgeons have the opportunity to evaluate results, step by step.
"Under general anesthesia, patients usually lie flat. It helps, however, especially when contouring the body or face, to have them in different positions, including supine, standing or turned one side or the other," he explains.
Today's less-invasive surgeries allow surgeons to consider some patients for local anesthesia.
"The thread lift is a lot easier on the patients than a regular facelift. Obviously, the face and neck lifts are much more involved and much harder to do under local — especially if it is a long case," Dr. Saadat says.
It is no secret that liposuction procedures for relatively healthy patients, during which surgeons remove only small areas of fat and focus on contouring the body, can be done under local anesthesia. Dr. Saadat gives the typical example of a patient with love handles who only wants what is equivalent to 20 cc or 30 cc of fat removed and contoured.
"A procedure like that is often best done under local and not general anesthesia, because once the patient lies on his or her back, it is difficult to evaluate the love handles. In these select cases, I might have patients stand while I contour the body," he tells Cosmetic Surgery Times.
Dr. Saadat's approach differs from traditional liposuction.
He first administers tumescent solution and asks that patients sit for 10 to 20 minutes.
"Then we use a 12- or 14-gauge liposuction cannula attached to a 10 cc or 20 cc syringe," he explains. "Using this approach, the surgeon has the opportunity to control the amount of suctioning that he does by pulling the syringe's plunger."
The approach puts the power of suction into the surgeon's control, allowing surgeons to more exactingly remove fat from precise areas.
"The other advantage of doing this technique is that you can hide the scar, because your entrance wound does not need to be very close to the liposuction site," he says.
Approaching the facelift
The thread lift with local anesthetic and patient participation is not for everyone.
Patients who come to Dr. Saadat with significant jowl ptosis and ptotic platysmal muscles are best suited for facelift surgery under general anesthesia.
"But if the jowling is minimal and there is no significant neck ptosis, then we can get away with doing a thread lift alone or in combination with a short scar, short flap, minimal lifting, perhaps including fat injections or other procedures to add volume under local anesthesia," he says.
The local anesthesia secret
Dr. Saadat uses more than local anesthesia to create conditions for successful patient participation. Whether using local anesthetic for the thread lift, liposuction or other procedure, he often takes the following approach: