Anaesthesia for Cosmetic Surgery

What kind of anaesthesia is used for cosmetic surgery?

At our hospital there are three options, and which one you have depends on your operation, your health and what you would prefer:

• Local anaesthetic: you are awake and the area is numbed. Used for small procedures such as mole, cyst or lipoma removal.
• Local anaesthetic with IV sedation: you are drowsy and relaxed through a drip, and the area is numbed. Used for some smaller operations.
• TIVA (total intravenous anaesthesia): you are fully asleep, with the anaesthetic given through a drip rather than as a gas. Used for most larger operations, including rhinoplasty, facelifts, breast augmentation and tummy tucks.

Many other hospitals keep patients asleep with anaesthetic gases. We use TIVA instead, and almost all our operations are day cases, so you go home the same day. If you would like to know exactly how TIVA works, see what is TIVA anaesthesia. This guide covers the choices, how safe they are, how you will feel afterwards and what to expect on the day.

Local, sedation or TIVA: how they compare

Which anaesthetic for which operation?

Choose your procedure to see the usual approach. Your anaesthetist and surgeon make the final decision with you, and an operation that is usually done with sedation can be done under TIVA if you prefer, or if it is combined with another procedure.

TIVA for cosmetic surgery: what it means for you

With TIVA, the anaesthetic medicine, based on propofol, runs continuously through a small cannula in the back of your hand or arm, and you usually fall asleep within a minute or two. A pump calculates the dose from your age, sex, weight and height, and a depth-of-anaesthesia monitor, which reads the electrical activity of your brain through a sensor on your forehead, helps your anaesthetist keep you at exactly the right level. There are no anaesthetic gases. Throughout the operation your anaesthetist monitors your heart rate and rhythm, blood pressure, oxygen and carbon dioxide levels, breathing and temperature.

Your anaesthetic is given by a consultant anaesthetist, who you meet on the day before anything starts and who stays with you throughout. UK national guidance on TIVA, from the Association of Anaesthetists, sets out how it should be given and monitored safely^[1].

Is TIVA safer than anaesthetic gas?

Not in the sense of fewer serious complications: both are very safe. Where TIVA makes a difference is in how you feel when you wake up.

• A 2024 meta-analysis of 317 randomised trials in EClinicalMedicine ↗, covering 51,107 patients, found no difference in deaths or serious organ complications between TIVA and gas. People who had TIVA were about 39% less likely to feel sick or vomit afterwards, less likely to wake up confused or agitated, and rated their recovery more highly^[2].
• A 2025 review of 385 trials in the British Journal of Anaesthesia ↗ found the same: no difference in serious adverse events, less sickness and agitation on waking with TIVA, although people woke slightly faster after gas^[3].
• In cosmetic surgery specifically, a series of 791 facelifts under TIVA in the Aesthetic Surgery Journal ↗ reported sickness after surgery in only 0.8% of patients, and no one needed to stay in hospital^[4].

So the honest summary is that TIVA does not make anaesthesia safer than it already is; it makes waking up more comfortable, with less sickness, which matters when you are going home the same day.

IV sedation: are you fully asleep?

No. With IV sedation you are drowsy and relaxed rather than unconscious: you breathe for yourself, you can respond if someone speaks to you, and many people remember little or nothing afterwards. The area being treated is numbed with local anaesthetic, so you should not feel pain. Sedation is different from TIVA, where you are completely asleep; the Royal College of Anaesthetists explains the levels of sedation in its patient guide^[5]. Sedation is sometimes called twilight sedation.

At our hospital it is used for smaller operations, such as liposuction of one area, upper eyelid surgery and a lip lift. You still need to fast beforehand, and a responsible adult must take you home and stay with you for 24 hours.

Local anaesthetic: awake for smaller procedures

For small skin procedures such as removing a mole, cyst or lipoma, an injection of local anaesthetic numbs the area and you stay fully awake. You feel a sharp scratch and some stinging for a few seconds, then pressure but no pain. For laser resurfacing, a numbing cream is used on the skin instead. You can usually go home soon afterwards.

Are you fit for anaesthesia? ASA grades explained

Anaesthetists use the ASA grade to describe how fit someone is for an anaesthetic. ASA 1 is a healthy person; ASA 2 is someone with a mild, well-controlled condition, such as asthma or high blood pressure that is well managed; ASA 3 and above means a more serious illness. For safety, we only operate on people graded ASA 1 or 2. If your health means you would be ASA 3 or higher, surgery at our Baker Street hospital is not the right choice, and we will tell you so.

Your pre-operative assessment checks this, and we may ask your GP for a summary of your medical history. If you have a significant medical condition you may be asked to have an anaesthetic review before surgery. We also limit operations to a maximum of five hours, because complications become more likely with longer operations. Read preparing for cosmetic surgery for what happens before the day.

Pain relief: TIVA with local anaesthetic

During your operation, your surgeon also injects long-acting local anaesthetic into the area, and anti-sickness medicine is given before you wake up. Our regular pain audits show that combining TIVA with local anaesthetic has minimised, and in many cases removed, the need for strong opioid painkillers, even after larger operations. That matters because opioids cause sickness, drowsiness and constipation. Published research points the same way: in one comparative study, women having a breast reduction with an opioid-free approach that included local anaesthetic needed far fewer painkillers afterwards and went home sooner^[6], and a ten-year series of 5,264 cosmetic procedures under intravenous anaesthesia with local anaesthetic recorded no unplanned admissions for pain, sickness or over-sedation^[7]. You can see more on our clinical outcomes and patient safety page.

Can you wake up during surgery?

It is extremely rare. In the UK’s national audit of accidental awareness (NAP5), awareness happened in about 1 in 19,600 anaesthetics overall, mostly when muscle-relaxing drugs were used, and in about 1 in 136,000 when they were not^[8]. The Royal College of Anaesthetists puts the overall figure at about 5 in 100,000^[9]. Depth-of-anaesthesia monitoring and a consultant anaesthetist beside you throughout keep the risk as low as it can be.

Side effects and risks of anaesthesia

Most people have no problems, or only minor ones that pass quickly. The Royal College of Anaesthetists gives these figures for anaesthesia in general^[9]:

Tell us if you have had a problem with an anaesthetic before, if anyone in your family has, or if you snore heavily or have sleep apnoea. For the wider picture, read the risks of cosmetic surgery.

After your anaesthetic: going home

You wake up in the recovery area within minutes of the end of your operation and rest on the ward until you are ready to go, usually a few hours later. A responsible adult must take you home by car or taxi and stay with you for the first 24 hours: we cannot discharge you without one. For those 24 hours, do not drive, drink alcohol, sign anything important or make big decisions, as the effects of the anaesthetic take time to wear off completely. Read about alcohol after surgery.

Before surgery, stop smoking, vaping and all nicotine four weeks before and stay off it for four weeks after (see stopping smoking before surgery), stop aspirin two weeks before unless it is prescribed for your heart or after a stroke, and tell us early if you become unwell: read surgery with a cold. Our hospital at 95–97 Baker Street is rated Good overall by the CQC.

Many people are more nervous about the anaesthetic than the operation. I always tell them the same thing: you will meet your consultant anaesthetist before anything happens, they will stay with you throughout, and most patients are surprised by how quickly and gently they wake up.

Dr Spyridon Vlachos, Specialist Plastic Surgeon and medical reviewer

References

Guidance comes from the official sources listed.

1. Nimmo AF, Absalom AR, Bagshaw O, et al. Guidelines for the safe practice of total intravenous anaesthesia (TIVA): joint guidelines from the Association of Anaesthetists and the Society for Intravenous Anaesthesia. Anaesthesia. 2019;74(2):211–224. doi:10.1111/anae.14428 ↗
2. Kampman JM, Hermanides J, Hollmann MW, et al. Mortality and morbidity after total intravenous anaesthesia versus inhalational anaesthesia: a systematic review and meta-analysis. EClinicalMedicine. 2024;72:102636. doi:10.1016/j.eclinm.2024.102636 ↗
3. Daccache N, Wu Y, Jeffries SD, et al. Safety and recovery profile of patients after inhalational anaesthesia versus target-controlled or manual total intravenous anaesthesia: a systematic review and meta-analysis of randomised controlled trials. Br J Anaesth. 2025;134(5):1474–1485. doi:10.1016/j.bja.2025.02.007 ↗
4. Moore ACM, Kachare SD, Barber DA, et al. Total intravenous anesthesia with dexmedetomidine for hemodynamic stability and enhanced recovery in facial aesthetic surgery. Aesthet Surg J. 2022;42(11):NP602–NP610. doi:10.1093/asj/sjac113 ↗
5. Royal College of Anaesthetists. Sedation explained ↗.
6. Parsa FD, Cheng J, Stephan B, et al. Bilateral breast reduction without opioid analgesics: a comparative study. Aesthet Surg J. 2017;37(8):892–899. doi:10.1093/asj/sjx038 ↗
7. Blake DR. Office-based anesthesia: dispelling common myths. Aesthet Surg J. 2008;28(5):564–570. doi:10.1016/j.asj.2008.07.012 ↗
8. Pandit JJ, Andrade J, Bogod DG, et al. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors. Br J Anaesth. 2014;113(4):549–559. doi:10.1093/bja/aeu313 ↗
9. Royal College of Anaesthetists. Anaesthesia and risk: patient information leaflets ↗.