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General Anesthetics and Facility Certification

Almost all the procedures discussed in this book can be done under the new local anesthetic combinations. In many cases relaxation medicines are also used. I believe that some of these procedures, such as liposuction, cannot be done as accurately under general anesthesia. So ask if you will need a tube in your throat to help you breathe (and ask about the extra charges for an anesthesiologist). Although there are those who would disagree, I believe the depth of the anesthesia makes more of a difference in your safety than who does the administering. General anesthesia presents more risk than local and/or sedation, and is rarely necessary (see chapter on anesthesia). Your doctor should operate in a facility that is approved by a regulatory agency. "State approved," "Medicare approved," and "Accreditation Association for Ambulatory Health Care (AAAHC) approved" are all acceptable. In some states, such as California, it is actually illegal to inject the heavier drugs in an uncertified facility. The certificate of approval should be posted in the waiting room, so ask to see it.

Having multiple procedures performed at the same time prolongs surgical time and requires a patient to be under anesthesia much longer. This is a dangerous practice in my opinion (see my medical journal article about complications and the article about the dangers of prolonged general anesthesia, both available in the Complications section of my website, There is opinion developing in the medical journals to back this up. The "total makeover" TV shows are encouraging a hazardous approach to cosmetic surgery, from both physical and psychological points of view. The fatality rate from a multiple-procedure, eight- to 12-hour cosmetic surgery using general anesthesia certainly is much higher than when each procedure is performed on a different day for a shorter duration. Try just one cosmetic procedure with a doctor, and see how it turns out. If you are happy, consider doing something else, if it's appropriate. While this might be a bit more expensive, your emotional and physical safety should be the first consideration.

Price Does Not Relate to Quality

The highest fees do not necessarily relate to the best results. When assessing fees, the factors to consider include the doctor's experience, the size of his practice, and even the location of his office. Be sure to ask about the number of specific procedures your doctor has done (see earlier in this chapter).

Some doctors may discount their fees for procedures in which they lack experience. They do this to attract as many new patients as possible so they can acquire the experience they need. While this is an acceptable practice, be aware the savings likely comes with a greater degree of risk.

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