If we were playing a high stakes game of true-or-false, we would bet a Birkin that something as science fiction as staying awake for a procedure like breast augmentation surgery or rhinoplasty would be complete hooey. It’s too outrageous! Too cringe-worthy! But, yep, it’s happening — and somewhat often. We needed to get to the bottom of this mind-boggle, so we sat down with Dr. Melissa Doft, a renowned New York-based board-certified surgeon. 

Understandably so, a lot of people are fearful of going completely “under” and losing all mental and physical capacity. Others have a tough time with the after-effects of general anesthesia and want to opt out of those possibly intense recovery symptoms (these range from nausea and dizziness to week-long post-operative delirium). These are a few of the reasons why “twilight anesthesia,” or Monitored Anesthesia Care (MAC) is growing in popularity. What’s the actual difference between these two approaches, you may wonder?

Well, with general anesthesia, a patient is put into a completely unconscious, coma-like state, intubated, and placed on a ventilator. This also means the patient loses control of their reflexes, as well as of the faculties of their entire autonomic nervous system. With twilight anesthesia, drugs are administered through an IV to induce a calm, sleepy state in which a patient can be easily awakened (or never completely asleep at all), still follow instructions, or respond to questions. Depending on what procedure is being performed, this sedation can last for as little as 15 minutes and as long as several hours. The drugs used are similar (including fentanyl, valium, midazolam, nitrous oxide, ketamine), but the dosages are much less than when a patient is entirely unconscious. Typically, local anesthesia (like lidocaine) is also used in conjunction with the MAC. 

While it all seems like a great alternative, there is one creepy possibility that could have many prospective patients running for the hills. According to Dr. Doft, “the negative is that you may feel parts of the surgery since the surgeon is limited by how much local anesthesia they can give due to toxicity.” Not to overstate, but that’s a pretty big negative. Dr. Doft prefers to use a deeper sedation for breast augmentations, not only because the patient is more comfortable, but because she performs her augmentations beneath the pectoralis muscle (eek!). “This dissection is easier for the patient if they are asleep,” she says. Of course, it all varies from doctor to doctor and procedure to procedure. But this technique is certainly worth exploring for those who have a fear-of-going-under roadblock between them and surgery. As always, do your due diligence and make the decision that’s best for you and your body.