Modern Anaesthesia for Plastic Surgery

What Are The Different Anaesthesia Options?

Essentially, three types of anaesthesia we use to ensure patient comfort and safety throughout the surgery.

1. Local Anaesthesia

This type is when we apply an anaesthetic injection to the surgical area, which will effectively numb the area and limit bleeding. This may be uncomfortable for 2-3 minutes until the anaesthetic takes effect, and the patient is awake and alert throughout the procedure. Dr De Silva does not recommend this option for the more delicate areas of the face, as this can cause patients unnecessary stress and tension throughout the procedure.

This is an option that many plastic surgeons offer, as few surgeons in the UK will offer sedation for cosmetic procedures.

2. General Anaesthesia

With general anaesthesia, an anesthesiologist will administer strong doses of anaesthetic medication that will put the whole body in an unconscious state.During treatment, a breathing tube helps and monitors breathing.. The downsides of general anaesthesia include a longer recovery period of hours, and there may also be some stronger side effects, such as drowsiness or nausea, making this option not suitable for all patients. Upto one third of patients may have sickness or vomiting after general anaesthesia as well as sore throat from the tube.

There are very rare and serious issues associated with general anaesthesia including thrombosis in the leg (termed DVT) or allergic reaction to inhaled anaesthesia. Most surgeons in the UK only offer patients general anaesthesia.

3. Sedative Anaesthesia

Also known as “twilight” anaesthesia, is a local anaesthetic coupled with sedative medications. At the centre, Dr De Silva developed his own specialised form of “twilight” anaesthesia, based on practices in the USA. This sophisticated sedation uses tiny amounts of four to five sedation medications that cumulatively give a relaxing and safe experience and avoids the risks and side effects of general anaesthesia. The level of sedation needs to be tailored to each individual patient and our anesthesiologist will monitor patients throughout the entire procedure.

Why Choose Dr De Silva?

  • Tired appearance; feel or look older
  • Self-conscious; avoid photos
  • Impact on relationships & profession
  • Difficulty with makeup; concealer to camouflage changes
  • Difficulty with makeup; concealer to camouflage changes
  • Genetic component; starting to look like your mother or father
  • Tried every lotion and potion to improve eyelids; minimal effect
  • Disappointed with non-surgical treatments like Plexa; <10% improvement

Patient safety is of key importance for all facial plastic surgery. The intricate anatomy of the eyelids requires precision and care. Dr De Silva is a keen advocate of patient safety and has championed the need for patient safety on Sky news and at medical conferences.

Why Is “Twilight” Anaesthesia Dr De Silva’s Preference?

This is the most advanced sedation technique available, with the highest level of safety and quickest speed of recovery. Dr De Silva considers this the best option for patients undergoing rhinoplasty, facelift, neck lift and eyelid surgery at his Centre in London.

Patients literally sleep through their surgery, just like when they are asleep at night. Dr De Silva and his team have developed their own specialised form of twilight anaesthesia, based on practices in the USA. This sophisticated sedation uses tiny amounts of four to five sedation medications that cumulatively give a relaxing and safe experience, avoiding the risks and side-effects of general anaesthesia.

In the NHS, sedation can mean having a single medication (commonly midazolam). This is limited in its effectiveness, so Dr De Silva’s team uses a more sophisticated form of sedation.
Patients under this sedation are conscious and breathing themselves. However, they are very relaxed and often euphoric.

Typically, patients do not remember the procedure. The recovery period is much shorter than general anaesthesia. Dr De Silva trusts all his anaesthesiologists, they specialise in sedation and have completed thousands of cases. Sometimes patients can remember falling asleep just before the sedation takes effect and waking up as the sedation is stopped. If you have known breathing issues or take sleeping tablets then the anaesthesia has to be tailored to you.

Modern Anaesthesia for Plastic Surgery

Is It Safe?

Sedation is a very safe form of anaesthesia for plastic surgery as you are literally sleeping during the surgery. You are breathing yourself and all your protective reflexes are working normally.

The sedation could be stopped at any time and you would just wake up. Sedation anaesthesia is far less invasive than general anaesthesia.

What Are The Side Effects?

As with any medication, the use of sedative anaesthetic agents can result in side effects. Notably, the incidence of side effects with sedation is far less than in general anaesthesia: drowsiness, dizziness, shivering (4%), headaches (4%), and post-sedation nausea & vomiting (0.7%).

Modern Anaesthesia for Plastic Surgery

What Is The Patient’s Experience Like?

“Sedation was a simple “pleasant” and easy experience. As I am usually a very nervous person you can imagine how I worried about all the complications of general anaesthesia and all that could go wrong. Needless to say, I also worried about “Sedation”.

However, I went ahead with the procedure and was put at ease by very a warm and friendly team of doctors and nurses, who explained how I would be sedated and what drugs would be used and what each would do to me. I wasn’t anxious or nervous and as soon as I got the first shot I drifted off.

As the procedure came to an end, I recall simply slowly waking from peaceful rest. I was completely calm and not disorientated at all. I did not feel confused or nauseated… it was just like the 3 hours had passed and nothing had happened. Only I had had the procedure.

I was slightly off balance but knew fully where I was and after 30 mins was able to get up and walk out of the centre. As I had had general anaesthesia before I feel this is definitely the better option for procedures like Rhinoplasty. Especially as there is no long wait post-op and also no side effects at all. I would strongly recommend it to anyone.

It’s safe comfortable and leaves no haziness afterwards.” – Dr De Silva’s Patient

Modern Anaesthesia for Plastic Surgery

Who Completes The Sedation?

All the doctors who complete anaesthesia for Dr De Silva are very experienced, having treated tens of thousands of patients. If you would like to speak with one of our anaesthesiologists beforehand, please ask.

Ask Our Experts

100s of experiences of Dr De Silva’s patients

Real Self. Top Doctor - Blepharoplasty 2020


4.98 from 592 reviews

By EL, Lower Blepharoplasty with fat transfer, laser and milia removal on May 19, 2020

I had lower eye blepharoplasty, with fat transfer, laser resurfacing and milia removal. I had researched and wanted the surgery for about 2 years before deciding to have some consultations I had two consultations with a well known surgery group but did not feel confident. I then met with Dr De Silva and knew as soon as the consultation was over that I felt confident enough to go ahead and am so glad that I did. My pre treatment appointments and advice were so thorough, and any questions that I had were answered so quickly by the clinics staff. The day of my surgery was seamless, and I felt in completely safe hands the entire time from the nurse Ellie, to the Dr performing sedation and Dr De Silva.
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By Upper & lower blepharoplasty Jan 1, 2020

I recently underwent an upper & lower Blepharoplasty with Dr DeSilva and the results are outstanding! From my very first consultation and after lots of research, I knew that I had made the right decision to go with Dr De Silva. Naturally I was nervous but his amazing team were all very kind, extremely friendly and totally relaxed. The procedure was carried out under sedation and that too was fantastic. I can honestly say I felt no pain during and after the procedure and within 1 hour afterwards I was on my way home. I would 100% fully recommend Dr De Silva to anybody considering a procedure such as mine. Thank you Dr De Silva, you have instilled a new found confidence in me.
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Lower Blepharoplasty Dec 25, 2019

I had lower blepharoplasty surgery as I had a lot of wrinkles in my lower eyelids. I have big eyes so the wrinkles were very obvious and only being in my mid-thirty’s I felt it aged me. The surgery was only an hour long and Dr Julian and his team were all really nice and caring. I am extremely happy with the results and my eyes look so much better! The wrinkles are hardly there and I actually like how my eyes look in photos now! I definitely recommend Dr Julian and his team.
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Read More Reviews Here *Results May Vary

Patient experiences with Dr De Silva

All these patients underwent eyelid surgery with Dr De Silva. We encourage patients to watch one or two videos of patient experiences to have a good understanding of healing and the recovery period. Dr De Silva and his team will provide support and reassurance during your recovery, we believe that being a well-informed patient is helpful to most patients undergoing eyelid surgery.

Watch Video: Dr Julian De Silva Blepharoplasty Review & Testimonial
Dr De Silva Blepharoplasty Review & Testimonial
Watch Video: My Blepharoplasty Surgery, my patient fears and concerns…
My Blepharoplasty Surgery, my patient fears and concerns...
Watch Video: My Upper Blepharoplasty experience with Sedation Anaesthesia…recovery story with photos
My Upper Blepharoplasty experience with Sedation Anaesthesia…recovery story with photos
Watch Video: My Upper & Lower Blepharoplasty experience with Sedation Anaesthesia…recovery story with photos
My Upper & Lower Blepharoplasty experience with Sedation Anaesthesia…recovery story with photos

How Do I Prepare for Anaesthesia?

Before, during, and after your procedure, our specialised anesthesiology team will ensure patient safety and comfort. We provide full instructions for each patient such as designating a responsible driver, food intake, and other necessary information.

If you would like to learn more about your sedation options during rhinoplasty, please contact us for a consultation. We are located in Central London and we will be happy to answer any questions you may have!

Will I Remember The Surgery?

Typically, patients do not remember the procedure or the short period of time following it, though you will feel a little euphoric. Occasionally patients can remember just before having sedation and waking up afterwards.


I Had A Bad Reaction To General Anaesthesia. Is There An Alternative?

Many patients who come to see Dr De Silva have had a challenging time with general anaesthesia including longer recovery or feelings of sickness. For more than five years we have been offering patients a modern alternative: sedation anaesthesia. Sedation anaesthesia has a much easier recovery with most patients feeling fine even thirty minutes after surgery and much fewer feelings of sickness.

Safety is always the number one priority. With sedation anaesthesia, you literally sleep during the surgery, breathing yourself with your natural protective reflexes working normally, the sedation could be stopped at any time and you would just wake up from sleeping.

Frequently Asked Questions

  • What is the recovery period for general anaesthesia?

    Most patients take 4-6 hours to recover from the anaesthesia and a good proportion have nausea from the general anaesthesia.

  • What is the recovery period for sedation anaesthesia?

    The recovery period is much shorter than general anaesthesia, with most patients able to leave between 30 to 60 minutes after the procedure.

  • Can I go home after surgery?

    The recovery time after sedation anaesthesia is relatively short and we offer our patients supportive aftercare that includes the services of an experienced nurse overnight, this ensures that you have the reassurance and comfort of receiving the best possible attention. Every patient’s experience is important to us.

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