The Coronavirus Outbreak Has Changed Everything. Awake Surgery as the Preferred Method for Plastic Surgery

Awake Surgery in the Present and Future

Awake surgery, or surgery under local anesthesia, is quickly gaining traction as the method of choice for a variety of medical procedures. Double board-certified plastic surgeon, Justin Yovino MD and his medical team have used this preferred approach for well over a decade at their Ideal Face and Body of Beverly Hills clinic. In awake surgery, which avoids the highly invasive protocols of general anesthesia, the patients breath on their own and do not require any artificial devices to maintain basic life support such as breathing. Not only does Awake Surgery limit the possible (albeit rare) risks of adverse events which are more likely to occur with general anesthesia, but warrants special consideration given the present pandemic of the Coronavirus (COVID-19) disease.

Awake Surgery in the Time of Coronavirus

Avoiding the unnecessary ‘tube down the throat’ and accompanying ventilator is now more important than ever with this current coronavirus situation. Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus. The viral pandemic has brought a new meaning to the saying “going viral.” It is highly contagious and social distancing is recommended to prevent the spread during this time. Treatment of the disease may require a doctor to place a sick patient on a mechanical respirator. And this has occasioned wide-spread panic about the availability of ventilators throughout the country. In fact, use of ventilators has been commonly used as Life saving maneuvers for most of the very serious cases of COVID-19 infections. Such considerations raise the question, should a patient be subjected to a breathing machine when they are generally healthy and can breath independently? It seems more prudent to let the lungs move naturally and breath clean oxygen; to maintain control of one’s own breathing.

The Difference Between Local and General Anesthesia

As mentioned above, local anesthesia is utilized when a patient is awake during surgery. The surgeon wears gloves, a mask, and eye protection when numbing medication is injected throughout the surgical site. An N95 mask is not required but a ‘surgeon’s mask’ is recommended. Minimal sedation is common. The relaxation is achieved with medications by mouth and/or laughing gas. The awake patient inhales room air and maintains control of breathing.

In contrast, general anesthesia results in an unconscious patient and requires support of the airway and breathing. Medications are delivered by intravenous (IV) access and the lungs. Supplemental oxygen is given through a laryngeal mask or an endotracheal tube. During general anesthesia, depending on the surgeon, numbing medication may or may not be placed. The doctors at Ideal Face and Body understand the power of local anesthetic, therefore it is always injected when general anesthesia is administered. See link:, to learn more about Dr. Sarah Yovino MD, double board certified physician, who leads these deeper levels of anesthesia at Ideal Face and Body.

Some Benefits of Awake Surgery

When feasible, the advanced surgeon prefers awake surgery. The rationale includes: lack of sore throat and no need for food and drink restrictions before surgery. Furthermore, patients feel hydrated and satiated and this helps healing. Prolonged nausea and vomiting, often a result of general anesthesia is seldom reported. There is less pain, faster recovery, and maintenance of good health. Serious complications such as deep vein thrombosis, a rare event, associated with general anesthesia is almost unheard of with awake surgery. Staying conscious allows one be fully present, and participate in the outcome. For instance, In the case of liposuction, there is nothing more satisfying to a patient than seeing their stubborn fat leave their body and go into the canister. Finally, being awake leads to a quicker return to work and less use of precious vacation time.

Awake Surgery in the Past, Coronavirus Present, and Future

The previous decade at Ideal Face and Body has brought tremendous advancements. Advanced awake surgery has become possible with excellent local anesthesia technique. Cosmetic soft tissue procedures, such as suction-assisted laser radiofrequency liposculpture and breast lifts, fortunately, no longer require general anesthesia.

2020 and the onslaught of COVID-19 has changed the culture and considerations of how we do plastic surgery. At the time of this writing, there is a quarantine and the country is on lockdown. All non-essential activities are on hold, and most centrally, this includes elective cosmetic surgeries! To the extent that Awake Surgery can avoid the unnecessary use of the ventilator as is appropriate, is arguably a number one priority.

And Although daily life has changed forever, we are all hoping for a return to normalcy and a return to successful, rewarding, and safe plastic surgery sometime this Spring. The world will emerge from the sedentary lifestyle, and surgical body contouring will be back on the radar. In the foreseeable future, the focus will likely be to look good and stay healthy and awake during surgery.

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