Today’s Cosmetic Surgery Anesthesia Techniques « Secrets of a Beverly Hills Cosmetic Surgeon

Photo: Robert Kotler, MD, FACS

Today’s cosmetic anesthesia techniques and medications are extraordinary! The above photographs tell it all. The photo on the left taken at 2:26 pm shows a patient who has just completed a five-hour face and neck lift. The dressings are in place and the patient is about to be taken to the recovery room.

The second photo taken 3 minutes later at 2:29 pm shows the patient at her station in the recovery room fully responsive and when asked, “How are you feeling?” gives the thumbs up sign. That is a strong indication that the patient’s faculties and brain function are intact.

The third photo is taken at 3:48 pm, approximately one and a half hours after the patient emerged from the anesthetic. She is alert, pleased, and particularly joyful because she had a history of having nausea and vomiting with a previous surgery. The patient will now be transported to a professional recovery facility where she will be observed overnight before she sees her surgeon the next day.

What is significant is that the patient had a particular cutting edge anesthesia technique. This technique is known as “PK” anesthesia. The “P” stands for propofol and the “K” stands for ketamine. Now propofol, which is the chemical name for the medication marked as Diprivan, has gotten a lot of attention recently because it has been implicated in the improper prescribing of medications for Michael Jackson. However, that should not at all dissuade anyone from availing themselves of this marvelous anesthetic which has a very quick onset and a very quick “wakeup.” The “K” medication, ketamine, is a perfect partner for the propofol. The medication places the patient in a detached state whereby they are conscious but are totally isolated from any stimulation and, therefore, pain is not registered in the brain. While the patient is maintained on the propofol medication throughout the case, the ketamine is used only in anticipation of when local anesthesia is injected. Understand that the operation relies on local anesthesia – administered after the propofol-ketamine has been given intravenously – to render the tissues pain free.

It is remarkable that the patient required no oxygen, did not have a mask or tubes on her face or in her nose. She received no narcotics or any other medication that might be apt to make her nauseous and delay the emergence from anesthesia.

This technique has been popularized, worldwide, by anesthesiologist Barry Friedberg, MD. Dr. Friedberg, who is on the faculty of University of California, Irvine, is author of a very specialized medical textbook for cosmetic surgeons and anesthesiologists entitled, Anesthesia in Cosmetic Surgery.

- Robert Kotler, MD, FACS