Anaesthesia is what people fear most and what gets explained least. The short answer: for rhinoplasty and facelift surgery I always use general anaesthesia; for the rest of my operations, sedation with local anaesthetic or general anaesthesia, depending on the case. I always operate in a hospital and with the same anaesthetist I have worked with for years, who interviews you before surgery and does not leave your side until you wake up.
On this page you will find which anaesthesia each operation involves, what it feels like, what is normal afterwards and how the day of surgery unfolds, from the moment you arrive at the hospital until you go home.
| Rhinoplasty and facelift | General anaesthesia, always. |
|---|---|
| Other operations | Sedation with local anaesthetic, or general anaesthesia, depending on the case. |
| Where and with whom | Always in a hospital and with the same anaesthetist. |
Who puts you to sleep
My anaesthetist has been the same for years, and interviews you before surgery at the pre-operative assessment: reviewing your medical history, your blood tests and any medication you take, and deciding with you which type of anaesthesia is right for you. On the day of the operation, your anaesthetist is at your side from the moment you fall asleep until you wake up in recovery, and does nothing else. While I operate, there is a doctor dedicated solely to you.
I always operate in a hospital, and anaesthesia is one of the reasons: a fully equipped operating theatre, a recovery unit and intensive care in the same building. I explain this in Where I Operate.
Which anaesthesia I use for each operation
For rhinoplasty and facelift surgery I always use general anaesthesia, with an anaesthetist who has worked with me for years. It is neither the cheapest option nor the quickest; it is the safest, and the one that allows me to operate with precision and you to wake up having felt nothing.
For everything else, the anaesthesia depends on the operation and on you:
| Rhinoplasty | General anaesthesia, always. |
|---|---|
| Facelift | General anaesthesia, always. |
| Blepharoplasty | Sedation and local anaesthetic in most cases. Local anaesthetic alone if you prefer to stay awake or cannot have any other type of anaesthesia. |
| Otoplasty | Local anaesthetic, with or without sedation depending on the patient. |
| Mentoplasty | Local anaesthetic and sedation. If performed together with a rhinoplasty, a single general anaesthetic. |
| Labiaplasty | Local anaesthetic, sometimes with light sedation. |
| Abdominoplasty | General anaesthesia. |
| Mastopexy | General anaesthesia. |
| Breast augmentation | General anaesthesia with a laryngeal mask, which does not leave you with a sore throat when you wake up. |
| Breast reduction | General anaesthesia with a laryngeal mask, which does not leave you with a sore throat when you wake up. |
| Liposuction | Sedation and local anaesthetic, or general anaesthesia, depending on the extent of the surgery and whether it is combined with another operation. |
| Brachioplasty | Sedation and local anaesthetic, or general anaesthesia, depending on the extent of the surgery and whether it is combined with another operation. |
Where there is more than one option, the decision is made between the anaesthetist, you and me at the pre-operative assessment. How long each operation takes and whether it requires a hospital stay is explained on its own page.
General anaesthesia, sedation and local anaesthesia: how they differ
- General anaesthesia. You are in a state similar to a very deep sleep, produced by medication given through a vein, with no anaesthetic gases. You are unconscious: you feel nothing and remember nothing. It can only be given in an operating theatre.
- Sedation. A sedative, which leaves you calm and drowsy, is combined with local anaesthetic, which takes away the pain. You are not fully asleep, and it is common to remember very little afterwards. It is the option when local anaesthetic alone is not enough, or when you do not want to be aware during the operation.
- Local anaesthesia. Only the area being operated on is numbed. You are awake, you can talk to the team and, once it is over, you go straight back to your room or home.
What general anaesthesia feels like
Nothing, and that is what surprises almost everyone. In theatre, a cannula is placed in your arm and you are connected to monitors for your heart, blood pressure and oxygen. The medication goes in through the cannula and you fall asleep within seconds. The breathing tube is placed once you are already asleep and removed as you wake up, so you have no memory of it.
There is no sense of time passing. The next thing you notice is that you are in the recovery room, with a nurse at your side, and the operation is already over.
With sedation the feeling is different: you notice yourself relaxing, everything seems to matter less and, before you know it, we have finished.
Is anaesthesia safe? Risks and side effects
Modern anaesthesia is very safe, and safer still for a healthy person having planned surgery, in a hospital, with an anaesthetist who has assessed them beforehand. Today’s techniques and drugs have greatly reduced both complications and unpleasant experiences.
The usual side effects are mild and pass on their own:
- Nausea or vomiting in the first few hours. It is prevented and, if it does occur, treated straight away.
- A sore throat or hoarseness for a day or two, from the breathing tube.
- Drowsiness, and poorer memory or concentration, for a few hours.
- Numbness in one area after a long operation, caused by positioning. It disappears within a few days, and to prevent it your body is well padded throughout the procedure.
If you wear dentures or have any problem in your mouth, tell the anaesthetist: this is to protect your teeth when the tube is placed.
Serious complications, such as a severe allergic reaction, a heart problem or a pulmonary embolism, are extremely rare: they occur in 1 in 250,000 people. In a healthy person, general anaesthesia leaves no long-term after-effects: its effects wear off within hours or a few days.
Your own risks depend on your health, not on a statistic. That is why the anaesthetist goes through them with you, one by one, before the operation. If anything in your pre-operative tests is not as it should be, surgery does not go ahead until it is.
After anaesthesia: what is normal and how long it lasts
You wake up in the recovery unit, next to the operating theatre, with a nurse looking after you and the same monitors still attached. It is normal to feel sleepy, a little cold and dry-mouthed. Any pain or nausea is treated there and then, before it gets worse. Once you are fully awake and stable you go up to your room, or to the discharge area if you are going home the same day.
Sleepiness comes and goes for the rest of the day. It is normal to sleep more than usual that afternoon and night, and to feel a little slow or absent-minded. After 24 hours, most patients feel clear-headed.
During those 24 hours, do not drive, do not drink alcohol and do not make important decisions: you may feel clear-headed without fully being so. If you go home the same day, an adult must collect you and stay with you for the first night.
How to prepare: medication, smoking and fasting
You receive all of this in writing before surgery, with your exact times. The essentials:
- Medication. Bring to the pre-operative assessment a list of everything you take, including vitamins and herbal products. Do not stop any anticoagulant (blood thinner) on your own: the anaesthetist will tell you whether it needs to be stopped and when. We also tell you which anti-inflammatories and supplements to stop, because some increase bleeding. If you use drugs such as Ozempic, Wegovy or Mounjaro, always say so: they slow the emptying of the stomach and must be stopped one month before surgery.
- Smoking. Stop smoking, and any other form of nicotine, at least four weeks before surgery and four weeks after. Nicotine narrows the small vessels that keep the skin alive, and that means wounds that do not heal and worse scars.
- Fasting. Surgery is carried out on an empty stomach, including under sedation. The general rule is nothing to eat in the six hours beforehand, and only water or other clear fluids up to four hours before. If you break your fast, say so: the operation is delayed, but no risk is taken.
- If you fall ill. If you have a fever, a cold or any infection in the days before, let us know before you go to the hospital. Sometimes the sensible thing is to change the date.
The day of surgery, step by step
- At home. Have a shower, do not wear make-up or creams, and leave jewellery and piercings at home. Come with someone.
- Arriving at the hospital. You are admitted a couple of hours before surgery. The nursing team prepares you and asks you the same things several times: your name, which operation you are having, whether you have any allergies and when you last ate. It is not disorganisation; it is the safety protocol.
- You see me. Before you go into theatre I come to see you, we go over the plan and I mark the area.
- Theatre. The anaesthetist places the cannula and the monitors, and you fall asleep.
- Recovery. You wake up with a nurse at your side. Once you are stable, you go up to your room.
- Discharge. Shorter procedures allow you to go home within a few hours and, in most cases, rhinoplasty patients go home the same day after a few hours of observation. After longer operations you spend one night in hospital and I discharge you at 24 hours, after seeing you myself.
You leave with written instructions, your pain medication prescribed and the date of your first follow-up appointment. What happens next is explained in Recovery and Follow-Up.
Frequently asked questions about anaesthesia
What does it feel like to have a general anaesthetic?
Nothing. You fall asleep within seconds of the medication going in through the cannula, you neither feel nor remember the operation, and the next thing you notice is that you are awake in recovery.
How long do the effects of general anaesthesia last?
Drowsiness comes and goes during the first day, and after 24 hours most patients feel clear-headed. Your throat may be sore for a day or two.
Is it normal to feel very sleepy after general anaesthesia?
Yes. It is normal to sleep more than usual on the afternoon and night of the operation. That is why you should not drive or be left alone during the first 24 hours.
Which symptoms are normal after anaesthesia?
Sleepiness, feeling a little cold, a dry mouth, nausea and a sore throat. They are mild, are treated in recovery and pass within hours or a day or two.
Does general anaesthesia have lasting after-effects?
In a healthy person, no: its effects wear off within hours or a few days. Serious complications are extremely rare, 1 in 250,000 people, and the anaesthetist reviews your own risks with you before the operation.
Can rhinoplasty be done under local anaesthetic?
I do not do it that way. For rhinoplasty I always use general anaesthesia, because it is the safest option and the one that allows me to operate with precision.
Is blepharoplasty done under local or general anaesthesia?
In most cases, under sedation and local anaesthetic. If you prefer to stay awake, it can be done under local anaesthetic alone.
How many hours of fasting are needed before anaesthesia?
Six hours without food. Water and other clear fluids up to four hours before; after that, nothing. This is the general rule. Your exact time is given to you in writing with your theatre appointment.
If anaesthesia is what is holding you back
It is the most common fear, and it is almost always resolved by talking it through. Bring it to the first consultation: I will explain which anaesthesia your operation would involve and why, and before surgery the anaesthetist interviews you to review your case. You can book by phone or WhatsApp on +34 722 77 10 78.
What that first visit is like is explained in The First Consultation.