Local Anesthesia Safer for Plastic Surgery Procedures and Benefits Recovery

By Amiya Prasad, M.D., FACS

Cosmetic procedures continue to grow in popularity, especially as new techniques and advancements are made in the field of plastic surgery. Before undergoing a cosmetic procedure, it is critical for patients to consider the surgeon’s anesthesia preference. The difference should make or break your decision. Today, most, if not all, cosmetic procedures can be performed under local anesthesia, however, many plastic surgeons continue to place patients under general anesthesia despite the increased risk for complications.

Dermatologic Surgery (February 2012) published a study based on ten years of data from Florida and six years of data from Alabama and found that more than two-thirds of deaths and three-quarters of hospital transfers were associated with cosmetic surgery performed under general anesthesia. Liposuction, one of the most common cosmetic procedures, accounted for 32 percent of cosmetic procedure-related deaths and 22 percent of all cosmetic procedure-related complications under general anesthesia. No deaths were associated with liposuction under local anesthesia.

General anesthesia vs. local anesthesia with sedation
When a patient is placed under general anesthesia, the patient is placed on a respirator and an endotracheal tube is placed in the throat to help them breathe. A combination of drugs causes a deep sleep during the procedure and paralyzes the body. Some patients prefer general anesthesia because they want to make sure that they are completely knocked out and unable to remember anything about the actual procedure.

Unfortunately, complication rates are much greater under general anesthesia and the body is put at a greater risk. Following a surgical procedure, patients often have a sore throat from the endotracheal tube, are very fatigued and more likely to feel nauseated or actually vomit. Recovery is considerably longer because the body has to recover from the surgery and the general anesthesia.

Under local anesthesia with sedation, a patient is placed under intravenous (IV) sedation and the area that will be operated on is numbed. The patient is relaxed, comfortable and virtually unaware of the procedure thanks to light medication, but the whole body is not paralyzed. Local anesthesia is a much safer alternative to general anesthesia because it does not put the body under stress in the same way. Most importantly, fewer drugs are needed so recovery from the procedure is faster.

Following a surgical procedure where local anesthesia is used, a patient can walk easily out of the office and does not have the nausea common with general anesthesia. Under local anesthesia, a surgical procedure becomes much less invasive and the risks to the body diminish significantly.

Local anesthesia – a much safer option
The most recent studies by leading anesthesiologists, such as Barry Friedberg, M.D., share the professional opinion that most, if not all cosmetic surgery procedures, can be performed safely under local anesthesia with intravenous sedation. Despite this fact, a large percentage of people undergoing cosmetic surgery are still subjected to the risks of general anesthesia.

The reason for this may be financial. General anesthesia requires less prep time and more procedures can be performed in a day. However, the longer someone is under general anesthesia, the more stress it puts on the heart and lungs. With local anesthesia, the preparation time is longer and fewer patients can be accommodated in a day. But, the bottom line is that a patient’s safety should always come first – far more important than the financial bottom line.

Prasad Cosmetic Surgery and Medi-Spa uses LITE anesthesia (Local, Intravenous, Tumescent, Ease of recovery) with great success for our patients. LITE is safer and allows for a much quicker and easier recovery.

Deciding Factors For Choosing Your Cosmetic Surgeon


Amiya Prasad, MD, chief Oculofacial Plastic and Reconstructive Surgeon of New York’s Prasad Cosmetic Surgery & Medi-Spa addresses the criteria for prospective patients choosing a cosmetic surgeon. For those opting for cosmetic surgery of the face, eyes, or body, Dr. Prasad stresses the importance of doing research before choosing a doctor for surgical procedures is necessary to achieve optimal results.  An innovator and author, Dr. Prasad shares his twenty years of knowledge in the field of plastic and reconstructive surgery and lends this to determining the factors for choosing a specialized cosmetic surgeon.

Expertise in Plastic Surgery is a controversial issue.  Many surgeons simply claim to be the “best” or advise that if you “Ask for a board certified surgeon” you have completed your research. However, if you want to determine a physician’s level of expertise, follow this straightforward assessment. The first level of expertise is based on the formal training pursued by a surgeon. For example, a neurosurgeon has expertise in brain surgery based on formal training. A neurosurgeon can be easily regarded as having a higher level of expertise in brain surgery when compared to a General Surgeon who had less exposure to neurosurgery during training and did not pursue this type of surgery after he or she finished training.

Eye plastic surgery training is specialized compared to general plastic surgery. This extra focused training as a specialist has served as the foundation for my expertise in Cosmetic Eyelid Surgery. As an Eye Plastic Surgeon, I have spent much more time than a general plastic surgeon on advanced eye plastic surgery and have spent many years instructing other eye surgeons on the topic.  A second level of expertise is based upon types of experience. This can be quantified by the type of training pursued after residency, the number of years spent during and after formal training on specific types of procedures and whether or not the person has engaged in teaching others his craft.

In addition, an experienced cosmetic surgeon has numerous before and after photos and can produce a list of patients who have undergone the same procedure you are inquiring about  who would be happy to speak to you about their procedure.

Finally, the last level of expertise to inquire about is the professional development that the surgeon has pursued in his career. Has he written books on his topic? Does he attend professional meetings and make presentations there? The field of cosmetic surgery, as in all disciplines, requires the pursuit of continued professional education, constant refining of our skills and knowledge and an unlimited curiosity to learn about the newest and most modern technologies available.


Formal training is an excellent foundation for expertise. Experience, however, can bring expertise to a higher level. For example, a highly experienced pilot landed an airplane in an emergency situation onto the Hudson River. Would a recently trained pilot have been able to do the same?

Experience as a Cosmetic Eyelid Surgery specialist helps the clients who are considering eyelid surgery feel more secure about having a surgeon who has the “miles” to be more than familiar with their procedure. Author Malcolm Gladwell who wrote “The Tipping Point” and “Outliers” states that to master any skill requires “10,000 hours” of practice in order to be successful.  The same rule applies whether it is becoming a virtuoso performer, an Iron Chef, a master sculptor or a skilled surgeon.  Performing eyelid surgery daily for 17 years has enabled me to reach and surpass the “10,000 hour rule”.  Another mark of expertise is how well esteemed an artist is among his peers. It is important to ask whether a surgeon is called upon by others in his field to perform “revision surgery” or to fix undesired results. A surgeon who has been practicing for many years and is well respected by his peers will be able to describe to a patient the types of revision surgery he has performed over his career.


Any true artist will say that artistry is intrinsic, not learned.  The medical field uses a training structure which tends to attract more “square” personalities, that is people who are intelligent, detail-oriented and organized, but not typically creative and artistic. This essentially means that many plastic surgeons are not artists but rather surgeons who follow a visual formula for each problem. In some ways this explains the often seen “plastic” appearance found in many people who have undergone cosmetic surgery. As an artist, I recognized during my training that there was a certain disconnect between patients’ desires to look fresh and youthful and the results of the plastic surgeons’ procedures. I have learned to appreciate the “true character” of a person’s face and understand the balance of features so that I can create a more natural appearance instead of a “manufactured face”. I have found that the judgment of beauty and balance is intrinsic and an awareness  of the planes of the face and the dimensions of balance is difficult to communicate but easy to perceive.


Commitment in plastic surgery means that you will do your utmost to ensure that your patient achieves desired results. In order to accomplish that, you have to practice your craft ethically.  By that I mean that you have to listen to your patients and understand their aesthetic goals and their deep seated fears. You have to discuss honestly and openly how you will address all related issues. If a patient has unrealistic expectations, you need to tell them. If they are asking for a procedure that is outside of your expertise, you need to refer them to the right specialist. You should always encourage a second opinion.  And most importantly, never push a patient into a procedure if they don’t want it or don’t need it. It is imperative to be available for questions or concerns before and after surgery. The best cosmetic surgery practice provides all levels of care to its patients to make sure that they always look their best. We have an on-site spa which provides non-invasive skin care and we have our own line of skin care products to protect your skin and keep it healthy.

It’s hard to teach ethics to someone. Ethics is just something you have. Unfortunately, there is no measure for ethics when you screen physicians. Medical training for ethics is quite variable and ultimately depends on the trainee and his own experience.  As surgeons, we all have to determine which ideals will serve our mission. Caring for my patients the way I would care for my own family has been the core value which guides how I practice. It’s based on this core value that I developed techniques which make my patients comfortable, look natural and recover quickly. When choosing a surgeon, you should get a “caring, compassionate, and professional” feeling from the surgeon as well as the staff and the office environment. In order to achieve this goal, I work with the most qualified and attentive staff and I have invested in my state-of- the-art facilities to provide a cutting edge care in a comfortable environment.

I am committed to providing my patients with the best care possible.

Looking as Young as You Feel

Looking as Young as You Feel

By Dr. Amiya Prasad, M.D., F.A.C.S. – https://karldrogba.com/

Aging has many components – and for many millions of Americans who are reaching what was once considered “old age,” life goes on with an exuberance and energy that belies their 60, 70, 80 or even 90 years. On Sunday, the New York Times covered this remarkable phenomenon, and I’m including a link to this article, and the article itself, here in case you didn’t read it on Sunday.

While Ringo Starr is still rocking as he turns 70, and Betty White stars in a new sit-com at 88, not everyone is ready for active aging. Some honestly feel their age, and they slow down. However, many more aging Americans believe that they “look their age,” and they force themselves to slow down, just because they think they are supposed to slow down for no other reason than because they think they “look old.”

For those with the energy to rock on at 70 or 80, there is no reason to slow down just because of how they feel they look. If you know someone who’s slowing himself or herself down – only because of the way they think they look, tell them there are ways they can look as young as they feel.

Today, it is medically possible to dial back your “apparent” age by ten or twenty years, and there is no reason for people to look older than they feel, or live life slower than they’d like to. If you don’t believe me, ask Ringo Starr or Betty White.

Turn 70. Act Your Grandchild’s Age.
Published: July 9, 2010, The New York Times (c)

Ringo Starr celebrated his 70th birthday last week by playing at Radio City Music Hall and saying his new hero is B. B. King, still jamming in his 80s.
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Joining Mr. Starr in his 70s next year will be the still-performing Bob Dylan(“May you stay forever young”) and Paul Simon (“How terribly strange to be 70”). Following soon after will be Roger Daltrey (“Hope I die before I get old”) and Mick Jagger, who is reported to have said, several grandchildren ago, “I’d rather be dead than singing ‘Satisfaction’ at 45.”

A rock ’n’ roll septuagenarian was someone the gerontologist Robert Butler could have only dreamed of in 1968, when he coined the term “ageism” to describe the way society discriminates against the old.

Dr. Butler, a psychiatrist, died, at age 83, a few days before Ringo’s big bash. No one, his colleagues said, had done more to improve the image of aging in America. His work established that the old did not inevitably become senile, and that they could be productive, intellectually engaged, and active — sexually and otherwise. His life provided a good example: He worked until three days before his death from acute leukemia.

But as much as Dr. Butler would have cheered an aging Beatle onstage, his colleagues said he would have also cautioned against embracing the opposite stereotype — the idea that “aging successfully,” in his phrase, means that you have to be banging on drums in front of thousands — or still be acting like you did at 22 or 42.
That stereotype is almost as enduring as ageism itself.

“The stories that we hear tend to pull us toward the extreme,” said Anne Basting, the director of the Center on Age and Community at the University of Wisconsin at Milwaukee. “It’s either the stories of young-onset Alzheimer’s, or it’s the sky-diving grandmas. We don’t hear enough about the huge middle, which is the vast majority of folks.”

In fact, for most people, the 70s represents the end, not a beginning. Life expectancy in this country is still 78 — higher for white women, lower for men and blacks. It is rising, but not as fast, perhaps, as our expectations. As Gloria Steinem said of her 70th birthday in 2004, “This one has the ring of mortality.”

Yet with Clint Eastwood directing films at 80 and Betty White starring in a new sitcom at 88, the pressure for 70-year-olds is not to face mortality, but to kick up those slightly arthritic heels ever higher.

The eighth decade, said Dr. Basting, is “now seen as an active time of life: you’re just past retirement, that’s your time to explore and play mentally.”

But while many will be healthy, others will not. “There will be an increase in frailty and disability because people are living longer,” said S. Jay Olshansky, a demographer at the University of Illinois at Chicago who studies aging. For some people, an increased risk of stroke and Alzheimer’s “is going to be the price they pay for extended longevity,” he said.

The risk, gerontologists say, is that in celebrating the remarkable stories, we make those not playing Radio City, and certainly those suffering the diseases that often accompany old age, feel inadequate.

Social policy may only contribute to that pressure. The European Commission recommended last week that European workers not be allowed to retire before 70, to keep state pension funds solvent. In this country, Representative John Boehner of Ohio, the Republicans’ leader in the House, suggested raising the retirement age for Social Security benefits to 70 to keep the program afloat.

Thomas R. Cole, director of the McGovern Center for Health, Humanities and the Human Spirit at the University of Texas Health Science Center in Houston and the author of a cultural history of aging, said he hailed anyone who, borrowing a phrase from his mother, age 85, “is playing above the grass.”

At the same time, he said, “if we don’t pay attention to the dark side of our 70s and 80s, we’re not going to pay enough attention to the people who need help.”

“We’re going to make it look like if you’re sick, it’s your own fault; if you’re not having orgasms or running marathons, there’s something wrong with you. We need to think carefully about how to take care of people who are frail. We need to allow people to not feel like failures when they can’t do the things they used to do.”

He traces the origins of this “splitting apart” of the reality of old age — good and bad — to the mid-1800s, when people in the United States first experienced what he calls “the legitimization of longevity.”

Life expectancy was only 40, but people began to believe that humans could live to be old — which they defined as 80 or more.

“People first began to say, ‘I’m here to live a long life, and if I work hard and am a good person and am middle class, I will die a good death,’ ” Dr. Cole said, “ ‘and if I don’t do these things, I deserve a short life and a painful death.’ ”

That split persists, he said, in our obsession with health and longevity, visible to anyone glancing across a magazine stand.

“It assumes you can control these things through willpower,” he said.

Gerontologists tend to think of successful aging as taking advantage of what potential there is, staying as socially and intellectually engaged as possible. Our culture tends to measure it more in terms of how active people are.

“It wouldn’t do us a whole boatload of harm to reinstate some values to contemplation,” said Dr. Basting. “Part of the pressure on older people to be successful and give back and volunteer and be active and play tennis is that we are a culture of doing. We don’t really know how to be. That’s something that late life gives us, is time to be. But that’s stigmatized.”

We might take a new model from musicians and other artists growing older. Creative types tend not to retire, but their later work often reflects their different stage of life. Dr. Cole cited the roles and films of Clint Eastwood, and the songs of Mr. Simon. “Old Friends” reflected on the strangeness of 70 from a young adult’s perspective, but on an album released when he was 60, he sang of “growing old” from a first-person perspective.

On the other hand, Dr. Basting said, Mick Jagger might test the limits — can he really strut like that when he’s 75?

For boomers, it can be particularly jarring to watch the icons of the rock ’n’ roll era aging. Robert Kastenbaum, a 77-year-old psychologist who has written extensively on aging, compares it to a 50th high school reunion and meeting the girl you had a crush on.

“This bubble-headed girl who was too sexy to exist, there she is now as the most mature, sensible grandmother,” he said. “You think you can’t believe the difference. The fact is both of these things are true. She was truly adorable, now she is admirable.”

We need to recognize all those stages, he said, and not think there is some dissonance. “It’s tolerance of ambiguity.”

Dr. Butler might have agreed. In a recording of what was apparently his last interview, conducted less than two weeks before he died, and posted on The New Old Age, the New York Times blog on aging, he told Joshua Tapper, “Sometimes the oldest person in the room comes up with the most thoughtful thing — not always.

“I think we ought to have a realistic portrait of all different periods of life and not try to romanticize old age as the most wonderful, all these great old wise people,” he said. “I think that goes too far.”

Does the pressure ever let up? Maybe.

Dr. Basting, who has studied elderly theater troupes, recalled that one member declared that the age of 90 was “true freedom.”

“Anything you do, people are just shocked that you’re alive,” Dr. Basting said. “There’s no expectations at 90.”

Dr. Amiya Prasad: https://karldrogba.com/

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