Awake Plastic Surgery FAQ

Will I Feel Any Pain During An Awake Procedure?

During an awake procedure performed with local anesthesia, patients are not expected to feel pain during surgery. Local anesthesia works by numbing the surgical site and blocking pain signals from the nerves to the brain, allowing patients to remain awake and comfortable without experiencing surgical pain.

Most patients notice a brief pinch or stinging sensation during the initial injection of the local anesthetic. This sensation is short-lived and is quickly followed by numbness in the treated area. Once numb, pain should not be felt during the procedure.

Patients may sense gentle pressure but these sensations are normal and are not the same as pain. While the surgical area is anesthetized, patients are still able to move which is an advantage of awake procedures.

For example, during an awake liposuction, patients may be asked to change positions so Dr. Kim can observe how the body naturally shifts with gravity, allowing for more precise and customized body contouring. During awake eyelid surgery, such as upper blepharoplasty or eyelid ptosis correction, Dr. Kim will have patients open and close their eyelids during the procedure. This real-time feedback allows Dr. Kim to fine-tune eyelid height, fold formation, and eyelid muscle function to improve symmetry and achieve more natural-looking, tailored results.

Dr. Kim carefully tailors the type and amount of local anesthesia for each awake procedure to support patient comfort and safety. Awake plastic surgery with local anesthesia is considered a safer surgical alternative for patients compared with general anesthesia or intravenous (IV) sedation, while allowing for a controlled and comfortable surgical experience.

Is It Safer Than General Anesthesia?

Awake plastic surgery performed with local anesthesia is considered safer for many patients when compared with general anesthesia, primarily because it avoids the systematic effects of putting the body fully to sleep.

General anesthesia is associated with a broader range of risks. More common risks include nausea and vomiting, grogginess, confusion, low blood pressure, breathing suppression, sore throat, chills, and a prolonged recovery time. More serious risks include respiratory complications, aspiration, blood clots, heart rhythm disturbances, and stroke.

In addition, published medical studies have reported an association between exposure to general anesthesia and an increased risk of cognitive decline, including memory loss and impairment and dementia. Similar cognitive effects have also been reported with intravenous (IV) sedation, sometimes referred to as conscious or twilight sedation, which can still affect brain function.

Local anesthesia, which is used for true awake procedures, numbs only the surgical area and does not affect the brain or breathing. As a result, it generally carries fewer systemic risks compared with anesthesia methods that involve loss of consciousness.

For certain patients, especially those with medical conditions or factors that increase their anesthesia-related risks and make them more vulnerable to general anesthesia complications, awake plastic surgery may be an appropriate option. Candidacy is determined on an individual basis following a thorough medical evaluation.

Dr. Kim has performed awake plastic surgery using only local anesthesia for over 19 years, with a focus on patient safety, surgical precision, and individualized care. His Harvard Medical School thesis examined strategies to reduce anesthesia exposure in order to help decrease the risk of postoperative cognitive dysfunction.

What Is The Recovery Time For Awake Surgery?

Recovery after awake plastic surgery performed with local anesthesia is often faster and smoother for many patients when compared with procedures performed under general anesthesia. Because patients remain awake, the body’s natural physiology—including breathing, blood pressure, and mental alertness—is not significantly altered during surgery.

By avoiding general anesthesia and IV sedation, patients typically do not experience anesthesia-related aftereffects such as grogginess, nausea, brain fog, or prolonged fatigue and recovery. Many of Dr. Kim’s awake procedures, including more extensive surgeries such as awake facelift, awake abdominoplasty, and awake breast augmentation, allow patients to stand and walk out of the operating room, and often resume light daily activities sooner than with general anesthesia.

Many of Dr. Kim’s awake surgery patients are able to manage any postoperative discomfort with over-the-counter pain medication, such as acetaminophen, without the need for stronger opioid medications. This often contributes to a smoother postoperative experience with much less downtime and a quicker return to normal routines.

That said, recovery time with any surgery can vary depending on the individual patient, the specific procedure performed, and personal healing factors. Dr. Kim evaluates each patient individually and provides recovery guidance based on their procedure.

How Is Anxiety Managed If I Am Awake?

Dr. Kim has extensive experience performing awake plastic surgery on a wide range of patients, including those who feel nervous about being awake or who have a history of anxiety. Feeling anxious before surgery is common and often stems from uncertainty about what will happen or a perceived lack of control.

An advantage of awake plastic surgery with local anesthesia is that patients remain awake and aware throughout the procedure. Rather than being “in the dark,” patients can understand what is happening, remain aware of their surroundings, and communicate with Dr. Kim and his surgical team during surgery. Many patients find that this awareness and ability to converse helps reduce anxiety and provides a greater sense of control and reassurance.

For patients who experience higher levels of anxiety, they have the option to take an anti-anxiety (anxiolytic) medication before surgery. This medication is intended to help reduce anxiety.

Dr. Kim will address any concerns patients may have regarding comfort, anxiety, or the awake surgical experience and tailors the approach accordingly.

Which Procedures Can Be Done While Awake?

Many plastic surgery procedures can be performed awake using local anesthesia, without the need for general anesthesia or IV sedation.

Eyelid Procedures

Awake upper blepharoplasty
Awake double eyelid (Asian blepharoplasty)
Awake eyelid ptosis (drooping eyelid) correction
Awake subbrow lift
Awake lower blepharoplasty
Awake eyelid revision surgery

Face Procedures

Awake facelift (rhytidectomy)
Awake neck lift
Awake rhinoplasty
Awake brow or forehead lift
Awake lip lift
Awake facial revision surgery

Breast Procedures

Awake breast augmentation
Awake breast lift
Awake breast reduction
Awake explant (implant removal)
Awake breast revision surgery

Body Procedures

Awake tummy tuck (abdominoplasty)
Awake mommy makeover (combination procedures such as breast, liposuction, tummy tuck)
Awake liposuction
Awake arm lift (brachioplasty)

Am I A Good Candidate For Awake Surgery?

Many patients are good candidates for awake plastic surgery performed with local anesthesia. In fact, awake surgery often allows for broader candidacy compared with procedures performed under general anesthesia, because it avoids putting the body fully to sleep or a state of induced unconsciousness, and the complications and risks associated with general anesthesia and IV sedation.

Because awake surgery uses local anesthesia, it may be an appropriate option for patients who prefer to avoid general anesthesia, have concerns about anesthesia-related risks, have had prior negative experiences with general anesthesia, or have medical conditions that make general anesthesia less desirable. It may also be a preferred option for patients who are concerned about the potential cognitive effects of general anesthesia and sedation (e.g. memory loss and dementia). Awake procedures allow patients to remain awake and alert, breathing on their own, and physiologically stable throughout surgery.

Candidacy for awake surgery depends on several factors, including the specific procedure(s), the patient’s overall health, anatomy, comfort level, and surgical goals. Dr. Kim evaluates each patient individually and determines whether an awake approach is appropriate based on the patient’s needs. A personalized consultation is the best way to determine whether awake plastic surgery is a suitable option for you.

Is Awake Surgery Cheaper Than Traditional Surgery?

Awake plastic surgery performed with local anesthesia is not necessarily a lower-cost alternative to traditional surgery performed under general anesthesia. While certain anesthesia-related fees associated with general anesthesia may not apply, the overall cost of awake surgery reflects the level of surgical expertise, experience, precision, and individualized care required to perform complex procedures safely on awake patients.

Awake plastic surgery is a highly specialized approach that requires meticulous technique, advanced anesthesia knowledge, and careful intraoperative management. Performing surgery while a patient remains awake requires a refined skill set and extensive experience.

The cost of any plastic surgery procedure is influenced by multiple factors, including the surgeon’s experience, the complexity of the procedure, the techniques used, and the degree of customization involved—rather than the type of anesthesia alone. At Dr. Kim’s practice, pricing reflects a focus on surgical quality, precision techniques, safety, and tailored results.

Patients considering awake surgery should view it as a more advanced, expertise-driven approach to surgery, rather than a cost-based alternative. During consultation, Dr. Kim discusses procedural options, anesthesia approach, and individualized planning to help patients make informed decisions based on their goals and needs.

Can I Drive Myself Home After An Awake Procedure?

Patients are advised not to drive themselves home or to a hotel immediately after an awake procedure. Instead, it is recommended that patients arrange a ride with a partner, family member, friend, or caregiver.

A professional rideshare or car service may also be used to ensure a safe and comfortable return home or to a hotel. Dr. Kim and his team will provide postoperative instructions and can advise when it is appropriate to resume driving based on the procedure performed and the patient’s recovery.

What Are The Risks Of Being Awake During Surgery?

Awake plastic surgery performed with local anesthesia is generally well tolerated, but like any anesthetic approach, it can carry potential considerations and risks. These risks are typically different from, and often fewer than, those associated with general anesthesia, but they are important to understand.

One potential consideration of being awake during surgery is anxiety or nervousness during the procedure. While many patients feel reassured by being awake and informed, others may experience heightened anxiety. For patients who are concerned about this, anti-anxiety (anxiolytic) medication may be an option to help promote relaxation.

There are also risks related to local anesthesia itself, which are generally limited and may include localized discomfort or rare reactions to the anesthesia medication. Serious complications from local anesthesia are uncommon when administered appropriately.

Because awake surgery relies heavily on precise anesthesia technique, it is important to choose a plastic surgeon with the expertise and extensive experience performing awake procedures using local anesthesia using local anesthesia, including a thorough understanding of how to administer and manage local anesthetic dosing safely and effectively.

Dr. Kim’s approach to awake plastic surgery is designed to help minimize these considerations through careful patient evaluation, meticulous surgical technique, and extensive experience with local anesthesia-only procedures. He has performed awake facial and body procedures for over 19 years, allowing him to anticipate patient needs, manage comfort during surgery, and tailor the approach to support safety and reassurance.

Can I Listen To Music Or Talk During The Surgery?

Yes. One of the advantages of awake plastic surgery with local anesthesia is that patients are able to listen to music, talk, and communicate during surgery. Because patients remain awake and aware, they can interact with Dr. Kim and the surgical team throughout surgery.

Many patients find that listening to music or engaging in light conversation helps them feel more relaxed and comfortable during the procedure. Being able to communicate also allows patients to ask questions, receive reassurance, and feel more at ease knowing what is happening.

Overall, awake surgery allows for a calm, interactive experience while prioritizing safety, comfort, and surgical precision.