![San Diego plastic surgeon Dr. Katerina Gallus and her scrub tech Bri on the episode of their podcast "All the B's" where they chat about local anesthesia [When awake plastic surgery makes sense]](https://restoresdplasticsurgery.com/wp-content/uploads/2025/11/ALL039-thumbnail-1024x576.jpg)
Listen:
Watch:
Not all awake procedures are equal. Dr. G and Bri break down the surprising reason why some clinics push local anesthesia, what procedures actually make sense to do awake, and which ones should definitely stay in dreamland.
Trending stories:
Instagram, @frownies
E! News, Simone Biles Reveals the 3 Plastic Surgery Procedures She’s Done
Star Magazine, Why Sam Smith’s Parents Greenlit ‘Nightmare’ Plastic Surgery Procedure at Age 13
Awake plastic surgery-related articles:
New York Post, I’m a plastic surgeon — why I’d never perform an ‘awake BBL,’ I’ve heard absolute horror stories
People, A $15K ‘Awake BBL’ Procedure Is Trending Right Now, But Is It Safe? Patients Tell All
Transcript
Dr. G (00:02):
You are listening to another episode of All the B’s with me, Dr. G and my scrub tech Bri. Hey everybody. Welcome back. It’s All the B’s the unfiltered podcast about plastic surgery and a mishmash of celebrity nonsense by myself, Dr. G and Bri. Hey Bri.
Bri (00:23):
Glad you clarified Dr. G. Good morning.
Dr. G (00:25):
I know there’s a lot of Dr. G’s, Dr. Gallus, whatever. Anyway, yeah, we just made it back from an Allergan, well, I went to the Allergan Surgical Skills symposium, a lot of S’S together there on breast aesthetics. It was really good. It was in Vegas and Bri came along, right?
Bri (00:44):
I did. I accompanied by laying by the pool all day. Moral support.
Dr. G (00:50):
And ran into a resident that was supposed to be at the symposium, but was also laying by the pool all day. Right. So wild.
Bri (00:57):
Yeah. Well, not all day just at the end, but yeah.
Dr. G (01:00):
Oh, he just gave up and went out to the pool.
Bri (01:02):
He’s like, I’m out.
Dr. G (01:04):
Nice. But we did hang out with some lovely ladies that let us join in their private sushi room where we ate. Went to dinner for sushi, which was delicious, and then went and did karaoke, which I saw an article in the cut about it last night when I couldn’t sleep, and I was like, oh my God. It’s a thing to do these karaoke rooms.
Bri (01:26):
I wish we could show you some of the videos. I know we can’t. You also don’t want to hear that, but it was the most amazing. We are so bad. It’s so good. Our singing is just so heinous that it’s almost really great.
Dr. G (01:42):
I think I’ll just say we were just so bad, period. Full stop. Yeah, but when you’re in these rooms that are, thank God soundproof and you can sing your heart out and no one else has to listen to you, but the people that are in your room, it’s awesome. You can really let loose and sound terrible. You can. It was Dr. Jenny Page and Dr. Lindsay, I’m probably messing up her last name. Then there, lovely nurse practitioner, Wanda, and then her sister, another Jenny who joined us and put up with our singing. Lindsay brought wigs for us to embrace our alter ego while we were singing and we built a
Bri (02:25):
And then mid like and karaoke. Everyone’s flights got canceled the next morning and there was a small freak out and then we left.
Dr. G (02:32):
And then we left.
Bri (02:33):
Because everyone had surgery on Monday
Dr. G (02:37):
And it’s Saturday night, and we desperately wanted to get back to San Diego and for them to Atlanta, which they did make it back, thank goodness, but it was super fun. Love to do that again. Well, today we’re going to talk about what you can do under local anesthesia, which is everything or nothing depending on who you talk to, but we’ll break down that and then we’re going to talk about first Instagram at Frownies, which our producer Hannah brought to our attention and I probably had seen and scrolled past, but this is hilarious. Wait, the fact that you can sell these is,
Bri (03:22):
And this is instead of Botox?
Dr. G (03:25):
Well, yeah. It’s an accessible way. You basically tape your face every night and massage it and then go to sleep with stickers on your face, and then if you wear those every night for months, it’ll be better.
Bri (03:45):
And this is just supposed to, no wrinkles are forming at night.
Dr. G (03:50):
Yes. I mean, this isn’t actually new. I remember one of our old employees, Erin had cleavage and had those wrinkles that form in between your breasts, and so she
Bri (04:04):
People put pillows there.
Dr. G (04:05):
wears this silicone patch thing that would kind of keep your skin from wrinkling at night. So this is the same thing. Will it work? I mean, I guess so if you want to wear plastic tape all over your face every night, and it’s
Bri (04:19):
Some of these beauty trends that people do, I watch them and it’s like they cover their mouth, their face, their entire body is wrapped up in five layers of things, but I’m like, how far can all that stuff really go?
Dr. G (04:34):
I mean,
Bri (04:36):
They call it your morning shed
Dr. G (04:38):
Do your Botox and not worry about it. You know what I mean? You’re literally wearing all these patches at night to tape your face and then you just, they’re not retraining muscles, they’re just taping your skin back, avoid the way you sleep and the wrinkles forming. I don’t know. It just stretches out your skin overnight and then if you keep doing that every night, but the second you stop, you’re going to go back to moving your face.
Bri (05:07):
Yeah.
Dr. G (05:08):
Does it have you’re retraining anything? No. I think it’s just maybe a hydrating tape. I’m
Bri (05:15):
About to duct tape my face tonight and see how it works.
Dr. G (05:18):
Yeah, I guess no one’s sleeping next to you because I don’t even really You’re going to do that every night? I can barely wash my face, so yes, I do. I can attest to that.
Bri (05:31):
We were in Vegas in all fairness. I was drinking by the pool all day and I get into bed and I was like, I don’t even know if I can wash my face. She’s like, get your ass up and wash your face right now.
Dr. G (05:41):
Yeah, I can’t tolerate that. You have to wash your face, have to wash your face before you go to bed.
Bri (05:46):
Double drink that Jose was making me by the pool. Okay.
Dr. G (05:50):
That was like eight hours earlier.
Bri (05:51):
He did me dirty.
Dr. G (05:53):
I think the shots did you dirty, which I agree. I don’t know who in that group was ordering shots, but I was like, absolutely. You always should be washing your face before you go to bed, especially since we’re getting up in four hours, so you’re not going to feel better at four 30 in the morning when we had to leave to catch our plane.
Bri (06:11):
No,
Dr. G (06:11):
But can you imagine also trying to put those stupid tape things on? It literally has to be every night.
Bri (06:18):
No. No.
Dr. G (06:19):
Okay. No, that’s all I’ll say. I mean, or you can have a half hour appointment and be three months with no wrinkles. Amen. And get an actual glow up.
Bri (06:30):
Amen. Life is too short to not get Botox.
Dr. G (06:33):
It really is. I don’t think why even have an alternative to Botox? Just do the Botox. Speaking of bad Botox, et cetera. Our favorite show to bash All Star I day, I watch this. I know I did watch probably an episode and a half episode, I just haven’t gotten back to it, is Jessica Simpson shows up on alls fair as a botched plastic surgery face. So it’s a joke and they have to make her look insane. Right. That’s the premise of episode
Bri (07:06):
Initially when I saw this. Yeah. Initially when I saw this, I didn’t realize that she had prosthetics on for the show and I was like, oh my God, Jessica Simpson, you cannot come out after all these years looking like this. But no, the whole point of the show, I’m not going to spoil anything for anyone because there’s no plot. But yeah, it’s basically just like she has this husband and wants her to look like 30 years younger, otherwise he’s just going to have to have sex with groupies. So she does all this crazy plastic surgery. All she wanted was Botox and he made her change her entire body and face, and that was the premise of her acting debut.
Dr. G (07:49):
Yeah, so because she changes her face and then he dumps her anyway. Right. So then she wants a divorce.
Bri (07:54):
Yes.
Dr. G (07:56):
I just think, I don’t know, it’s interesting for a Kardashian to be involved in this, but
Bri (08:02):
i feel like all these, but divorces are just storylines from their lives that they’re just bringing into this, and in one episode, Kim k says she did not pass the bar and she put out on Instagram. She’s like, well, at least I’m a well-dressed lawyer on the show. Not in real life. Homegirl is wearing a thong skirt with her whole butt hanging out. I was like, that would never fly. Imagine showing up to court and your lawyer is just in a thong suit.
Dr. G (08:35):
Why is there a thong suit? Why are you missing the back of your suit? Let’s take a look at Jessica’s botched plastic surgery face. I think we’re just looking at her regular face. Yeah, she just looks,
Bri (08:48):
It was worse than that on the shot.
Dr. G (08:49):
It’s giving maga.
Bri (08:52):
Yeah, it was so
Dr. G (08:53):
Bad. Yeah, it’s just over. It’s the classic pillow face with overdone lips, overdone cheeks, no tear trough, can’t see the eyes. Really harsh makeup.
Bri (09:03):
They did a super, super tight and right fox eye lift. Everything was just pulled on the show, pulled and fluffed.
Dr. G (09:12):
Yeah. I mean, I’m surprised anybody even noticed, honestly, because the outfits on that show were crazy. The whole thing is bananas. That whole show is wild. Anyway. Well, all right. Speaking of good plastic surgery, Simone Biles reveals the three plastic surgery procedures that she’s done, and number one was her boobs, which they look great. I’m surprised. She looks so cute.
Bri (09:38):
Yeah, she looks, oh, I guess I’m not surprised in that picture, but I was going to say, you can’t even tell.
Dr. G (09:46):
She looks fabulous. She looks so good. Yeah, so she revealed, I forget, I think it was Botox, and I feel like one time she mentioned she had Botox and didn’t like it though. And I was like, well, you just didn’t have it done right. She had her boobs done, which looks fantastic and good
Bri (10:05):
Very complimentary to her body and a lower bleph.
Dr. G (10:09):
And she’s like two of them, you would never Oh, that’s right. She had a lower bleph, which is wild. And earlobe surgery, so the ear lobe surgery is something we do pretty commonly actually for either torn ear lobes or ear lobes that were there. It is. Oh yeah. Circling back to the thong suit, what the hell?
Bri (10:30):
You cannot show up wearing that. It’s like the mullet business in the front party in the back, business in the front. Ray J in the back.
Dr. G (10:41):
It’s terrible. It’s just, it’s so outrageous. It’s like the, anyway, I’ll just, they have no words. No words.
Bri (10:51):
If I show up in scrubs in the back of my scrubs, it’s just a thong.
Dr. G (10:56):
Someone was talking at my thing at the symposium about bringing back the scrub dress, and I was like, what? They’re like, I just got hot in the, or I’d rather have a scrub dress. And I was like, no, I do not want a scrub dress. No, that does not sound fun. If something spills. Yeah, there’s that much less between you and the drapes. No thanks.
Bri (11:17):
Our Monday’s case was a little messy and I can’t imagine,
Dr. G (11:21):
Right.
Bri (11:21):
Can imagine being a skirt or a dress.
Dr. G (11:24):
No. That stuff so scary down.
Bri (11:26):
I don’t like that one jumpsuit. Then you have to get fully naked to use the restroom.
Dr. G (11:31):
Yeah, A scrub jumpsuits also utterly stupid. And you really, maybe we should bring a buttless scrub.
Bri (11:38):
I’m going to do it. I’m just cut up an old pair of scrubs and see how it works. I thought a scrub. I see. Yes. I’m going to do it for April Fools and see how mad you are.
Dr. G (11:45):
Okay, I like it. All right. Let’s go back to Simone. She had a lower bleph, which I am kind of surprised. I didn’t think her eye bags were something, but if it bothers her, it bothers her and that’s awesome. So she’s back to being retired and she’s had those procedures, so good for her. And then speaking of this other title, Sam Smith’s parents’ Greenlit Nightmare Plastic Surgery procedure at age 13. I feel like the title of the article doesn’t
Bri (12:21):
Lipo.
Dr. G (12:22):
Yeah, but it doesn’t really, I feel like it’s, it’s shocking. It’s misleading because he makes it seem like it was about his weight and that he talked on a podcast co-hosted by Penn, who’s the guy from you and Gossip Girl, which is on constant replay in my house. At some point he had surgery on his chest, so it’s not like he lipo his flanks. He had 13 years old. He had a growing chest, so he had gynecomastia, just say gynecomastia weirdo. And so he got liposuction when he was 13. He couldn’t swim. He was embarrassed about his chest. He was getting teased. So I don’t know what’s the nightmare part? I’m confused.
Bri (13:05):
I feel like I recover
Dr. G (13:06):
Getting bullied by your chest and you treated it, and then
Bri (13:13):
I just feel like anything at 13, you’re just not old enough to have to recover and I’m sure take pain meds or whatsoever you’re just not. My 13-year-old fell off his bike and got all scraped up and he was laid up in bed for four days, unable to do anything. It’s just you can’t recover at 13 years old.
Dr. G (13:35):
Yeah, I mean, I do think so gynecomastia is super common. So two thirds of adolescent males will have some form of gynecomastia and the majority of those will outgrow it just a hormonal shift. But for some, it’s persistent. So I think in the adolescent male, this surgery can be life-changing, but I would say thirteens probably a little early. Early because you’re not done with your hormonal shifts and you’re probably going to get recurrent gynecomastia. So it really needs to be stabilized. So most plastic surgeons won’t do it until they’re like 15 or 16, at least it really needs to be extenuating circumstances. You don’t know if you’re actually going to hold onto the guided capacity or if it’ll just go away on its own and then you’re just doing unnecessary surgery. Or if it’s too early, it just comes back. But if someone’s really wrestling with getting bullied at school and you think it’s going to change, I mean maybe in narrow circumstances you can do it, but yeah, I agree. At 13 it’s a little,
Bri (14:43):
Would you have to take the glands out? What would
Dr. G (14:46):
Yeah, they do. I’ve done 13, 16 or 17. I did one that’s lipo only, but in general, you have to do a little bit of excision of the breast tissue that’s there.
Bri (14:58):
This just gives me more of an eating disorder type of vibe. He just keeps commenting about how he just couldn’t stop eating,
Dr. G (15:05):
Which has nothing to do with gynecomastia, but the fact that he keeps referring to his chest, it’s just confusing. But honestly, he’s what, 30 or something now? So remembering what happened to him at 13 is going to be a little muddled anyway, so yeah, it’s tough. You want to help your kid. I can understand the parents wanting to help their kid not feel embarrassed or bullied, but then also not create a new problem. All right, so enough about Sam Smith. I don’t know why it was a nightmare was that he wore a bandage for a year afterwards and he kept eating. Okay, so this kind of leads into our topic of local surgery, local anesthetic surgery. I’m a plastic surgeon, white never perform an wake BBL. And so I know someone that does spoke with Dr. McNally, Sean McNally about the upsides and downsides of being awake.
(16:02):
I mean, I know it’s Bri’s least favorite thing to participate in because patients are either so comfortable and chill or they’re not, and you don’t really know until you start.
Bri (16:15):
No in-between.
Dr. G (16:19):
My friend in Tampa does exclusively stuff under local, so awake, you name it, she can do it awake. However, people are coming from all over the country to see her and she’s not cheap and she’s doing it awake. And so those patients are highly motivated, highly motivated. I think the average patient that asks if it can be done awake are assume that it’s going to be easy and they’re not going to have pain with no insight onto their pain tolerance and they’re looking for cheap. And so this guy, Dr. McNally says the perks are there’s no anesthesia provider and either reduced or no facility fee, which makes the procedure more affordable. But the trade off is,
Bri (17:06):
Can I stop right there? Because I have seen so, so many, even before I met you and I was going to do an awake BBL, it was still more expensive than going under general. All of these that I’ve seen, none of ’em are cheaper. They have astronomical prices compared to going under general with facility with anesthesia. That doesn’t make it make sense. The math is not mathing.
Dr. G (17:31):
No, I agree. I think some places there are chop shops for cheap liposuction and you can get a great deal, but a lot of times some of these bigger chains upcharge quite a bit and it’s because they need to pay the surgeon out and they need to cover the overhead of having a chain like Sono Bella or Air Sculpt. Sometimes the list price is really high and then they give a deep discount, but not always. I think you’re right. A lot of times that guy that you were referencing, the skin and skinnier guy in La Jolla, I mean he is in La Jolla, so his prices were not cheap. It was like 11 grand, right? For an awake BBL.
Bri (18:10):
Yeah, I think it ended up being 13 or something.
Dr. G (18:13):
That’s crazy.
Bri (18:15):
Yeah, I think I ended up paying 11 grand to go under general, but I was quoted there at 13 or something. And then we had another person who recently was quoted by Elite or something, I don’t know, but she was like, if I come in in three days and get it done really quickly, but it was still thousands of dollars more.
Dr. G (18:35):
Oh, right. Yeah. Where she wanted to do it. They were pressuring her and I was like, why don’t you just come in for your follow-up girl,
Bri (18:41):
They’re giving me $4,000 off. If I come in in three days. How much is it there? It was an insane price.
Dr. G (18:52):
Yeah. So I would say the cost is not a reason because a lot of times the cost is not cheaper and also the cost should not be your deciding factor. It should be is a person certified to do the procedure? What’s their experience doing it? Is it safe? A lot of these places, the real reason they’re doing it under local anesthesia in the case of the skin and skinnier guy is because they don’t have a certified or So if you decide not to certify your or you can’t offer an anesthetic, you can’t do IV conscious sedation and you can’t do general anesthesia. So what does that leave you local? And technically you should certify to do a local anesthetic procedure, but no one’s really checking that
Bri (19:39):
Can you? If you’re an ER doctor?
Dr. G (19:41):
Yeah, there’s no, he’s not credentialed anywhere. So he is just doing it under local. No one will ever certify him for sedation. Right. You’re never going to get quad A to certify you because you have to show that you’re credentialed to do that. That’s what happened. There was a pediatrician that finally lost his license in LA or Orange County who was doing liposuction. You’re doing all of that awake. Why? Because you can’t do it any other way. It’s illegal for you to have an OR with anesthetic.
Bri (20:13):
What business does a pediatrician have doing liposuction.
Dr. G (20:16):
I don’t know
Bri (20:17):
Is there a weekend course?
Dr. G (20:19):
I guess so. Yeah. So that’s the other reason is that you’re doing it under local because you’re not credentialed to offer actual anesthesia. That’s very different from giving the patient the choice and then you best know what those max doses of lidocaine are because that dose is going to get pushed depending on who’s doing it and what you’re doing to make the patient comfortable. And at some point you hit the max dose and you can’t go any further. So do you abort the surgery? What happens is some of these doctors tend to fudge it a little bit and then either you don’t give the patient any more anesthetic and you have to hold still or you give them more anesthetic and then they get too much. And those are neither great options because either you’re going to be in a lot of pain or potentially if you’re going to have a complication from too much lidocaine, it’s usually not immediately. It’s usually that first 24 hours. So you go home and then have a problem.
Bri (21:18):
There’s also a cap on how much you can take out under local. It’s like
Dr. G (21:21):
Correct, 500 ccs If you’re certified. Right?
Bri (21:25):
Versus going under general, which is five liters.
Dr. G (21:28):
Correct. So those guys are already not following the rules. I guarantee they’re taking out more than 500 under local.
Bri (21:34):
They are. I have seen the videos and there is no way you can get a BBL, skinny BBL, whatever with only taking out 500 ccs because keep in mind also that’s a lot of fluid and a lot of tumescent as well. What half of that is fat? Maybe you’re going to put 1 25 in each booty.
Dr. G (21:53):
Yeah. So I agree. Those are all terrible reasons to do it under local. I think for some bigger cases, I think going under general gets me the best results because I’m not simultaneously worried about the patient’s comfort, which you just have to be when they’re awake. So if it’s a one small area or one area, I’ll do it, but I think people start doing total 360 lipo awake. It’s not tolerated. And you would think that the skinnier you are, the less fat for me to take would make it easier, but it’s not because what hurts is when that cannula, which is going in to suck the fat out, either gets too close to the skin or too close to the muscle, and so the thinner you are, there’s less room for me to get in there and get fat. So every time I touch skin or muscle of skin or muscle, it hurts. And even with the anesthetic in there, so often if you don’t have a lot of fat for me to take anyway, it sometimes can be more challenging under local. And then some areas are just more painful, the abdomen is hurts more, especially around the belly button. So that’s the area that usually ends up getting not as aggressively lipo because the patient doesn’t tolerate it. So you get a little donut around the belly button. So moving on to the $15,000 awake BBL procedure.
(23:26):
This is the article references this guy who is again, not a plastic surgeon, he is a Canadian. Oh, he had Canadian plastic surgery training. Swissa founder of squlpt spelled weird. Squlpt. This is just a disaster. This place, I think in my opinion, they do awake, lipo awake BBL, awake breast aug. But again, if you scroll down to the people offering it, they’re all, first of all, there’s
Bri (24:03):
Our, oh no. Yes, I am so sorry.
Dr. G (24:09):
I can’t. Okay, I can’t. There’s one board certified plastic surgeon out of all of them, it’s Bellamy who I’m pretty sure has had some issues. Scroll back up to Ray though. Robert Ray who is like never board certified Robert, DR 9 0 2 1 0. Oh, what is happening? Why are his arms oiled up? Why are his scrubs that? Why is his hair? I have so many questions. Why does he have a stethoscope around his neck? Why does he have a deep V?
Bri (24:37):
Oh I need zip down scrubs.
Dr. G (24:42):
And the butt. That’s our April fools. We need the cleavage bearing scrubs and then the thong.
Bri (24:51):
So excited
Dr. G (24:52):
It’ll oil up my arms, man.
Bri (24:55):
We should have done that for last staff pictures. We need a redo.
Dr. G (25:00):
I just can’t with these guys.
Bri (25:01):
Bring ’em back.
Dr. G (25:02):
So the article in people was about this place and how it’s been a disaster.
Bri (25:11):
It’s in Miami. So we could have left with that.
Dr. G (25:13):
Right? Well, they have franchises in California. That’s how you get Robert Ray. But these people were woefully I guess unhappy with the results and she said that she was back to work and doing fine, but these patients said that it was okay. And then I think the rest of the article is about people complaining about it. Oh yeah. Right, because my friend Usha comments, I love that Dr. Pol plastic surgeon in San Francisco Plastic Surgery and Laser Center, who’s a good friend of mine and I just saw her on a Zoom call. Actually it’s limited when it comes to larger areas. And that again, she points out what I’ve already said, which is some clinics offer procedures under local anesthesia because they might not be board certified plastic surgeon and aren’t authorized to administer general anesthesia.
Bri (26:11):
I can tell you that first patient picture, there was no way only 500 ccs were taken out.
Dr. G (26:17):
Right.
Bri (26:17):
So absolutely not.
Dr. G (26:19):
Yeah. Anyway, this place has been sued multiple times. So they’re also part of MIA Aesthetics, which if you see that I would just run honestly MIA aesthetics. They also have franchises. So sculpt is teamed up with them and they’re one of those practices that changes a name every time they get massively sued. So perfect. I would just say no, please vet who’s doing your surgery, honestly is all I can say. So let’s talk about local anesthesia some more. What can be done? Well, I would say the easiest thing to do under local anesthesia is something we are doing four times this week, which is a labiaplasty.
Bri (27:02):
Labiaplasties.
Dr. G (27:04):
Shockingly that is hands down. I would not put somebody under anesthetic for that because it doesn’t make any sense. So the topical anesthesia, the topical that we use, which is a 23.7 is so effective. I feel like you could almost do the procedure with just topical. I’m not suggesting that, but it really makes everything very smooth. So as soon as the topical is on, you’re pretty numb. And then so when I mark and then put the local anesthetic in, the patients literally don’t feel anything and you don’t feel anything until I’m done. Sometimes you might have one little twinge, but it’s literally I feel something maybe sharp and I just put more local in if I have to, but routinely I don’t. And then I put local in at the end of the case so that people have time to go home. And I just saw one of my patients on Monday that we did the week before, and she took the Jounavix, which we’ve been doing and no oxy, and she’s like, I didn’t even take all the Jounavix, which you just need to take twice a day. She’s like, it’s swelling, but it’s not. So I think that’s been working really well. If you want a narcotic free recovery, you can do that. Obviously I prescribe oxy.
Bri (28:17):
I tell every patient in the consult, I was like, well, it’s great if you’re really anxious to take one. You do not need one. No one has ever, once the procedure starts, half the people 10 minutes into it are like, have you started? She’s like, oh yeah, I’ve been going. It’s just the anxiety of laying there, thinking about your labia being cut. But it is like people do so well. You don’t really need anything in office for that procedure. Exactly. Be comfy when you get home. But yeah, that procedure easy under local. It seems so personal. It seems like a terrible area to have surgery on, but it is the easiest.
Dr. G (29:00):
Yeah, I would say hands down, yes, we do offer the oral sedative. You need a ride home if you do that. And I think if you’re going to be hard to get out of your head before it starts, that’s fine to take. But sometimes it just makes people more chatty. Sometimes people go to sleep, but either way, the ones who do it under regular, just straight local, have no issues. We literally haven’t had no issues.
Bri (29:23):
A couple patients after taking the sedative that say they want to go to the club right after, they’re like, I’m sorry, I’m ready to go.
Dr. G (29:29):
And we’re like, that’s not the effect we were looking for.
Bri (29:32):
Yeah, I was like, we’re downtown, no girlfriend, go home and go to bed.
Dr. G (29:38):
Ready to party.
Bri (29:39):
Yeah, it’s just like having a couple margaritas, some really good, the margaritas Ivan made me in Vegas. I bet it’s like having one of those. Or Jose.
Dr. G (29:50):
Oh my god. All right. So I would say our second most popular procedure under local for me is implant removal. Also fairly freaking easy.
Bri (30:01):
I was going to say that. Or Aveli.
Dr. G (30:03):
Yeah, those are both popular. I would say implant removal is easier to do under local than Aveli. It’s faster,
Bri (30:12):
Short and sweet.
Dr. G (30:13):
Yeah. I’m going to numb up your incision and take out the implant and close the incision and you’ll feel some pressure as we yank the implant out and then you feel immediate relief that is gone. And then that’s it. And you’re in a bra and you’re out of there. Again, you can take the oral sedative if you want, but just need a ride home. And it’s mostly just because you’re nervous about feeling stuff, which you won’t. Aveli highly recommend the sedative, right? That’s our cellulite reducing procedure. So I have to inject local anesthetic, that kind of fluid into your butt and thighs. And then I use a little device to cut the fibrous septae. So the little connections between the cellulite in your skin to the tissue underneath, and I’m cutting those and there’s just no faster way to do it. You have to go in hook, cut, hook, cut, hook, cut each cellulite. Dimple has about 10 to 15 little fibrous septae. I have to cut, then I have to go back through and make sure we got them all. So it’s an awesome procedure, but it takes a minute. So it’s usually an hour-ish of me doing that.
(31:19):
And people just, it’s not like it hurts, but you’re just tired of staying on your abdomen, you’re laying on your belly and it just gets old. So I think for that procedure, having the sedative makes time go by faster hundred percent in it, and so you lose a little track of time. So even if it seems long to you at the time, you won’t remember it. So I think that one’s well worth it. Dr. Chao does a ton of earlobe repairs.
Bri (31:49):
You do not need it.
Dr. G (31:49):
Local. Local. There’s no reason to need it. And upper blepharoplasty also probably don’t need it, but if you’re anxious, sure take it. I do notice that if patients are super anxious, their blood pressure is probably a little bit higher. So there’s a little bit more booing while I’m doing the procedure until they realize that it’s not going to hurt and then they calm down and the same thing for the eyes. So when you do a blepharoplasty, you can tell if the patient’s nervous. They’re just a little more oozy sometimes. So our backup for all of these, if you go down the local pathway and then you really are still just anxious is pron knock. So we give you nitrous oxide and you can chill out with that.
Bri (32:34):
Laughing gas?
Dr. G (32:36):
Yes. Which usually doesn’t make you laugh.
Bri (32:39):
No, not if you’re already in pain.
Dr. G (32:43):
No. What else am I missing? Other stuff. We do Alloclae under local. That’s an injectable though.
Bri (32:49):
Yeah, I feel like we’ve, I mean that’s kind of new, so I feel like over the course of doing so much, I would think maybe an oral sedative would be the way to go. I think it’s just a little uncomfortable,
Dr. G (33:05):
I think because the product itself stings, so once it gets in, it’s kind of painful and there’s nothing you can do about it. So you’re like, it’s burning, but and not for everybody, just for some patients. So that plus probably have to change that awake liposuction. I think it just depends on the patient and we can’t do too many areas. Some people do really well.
Bri (33:27):
Yeah, some people who I think are going to do, we did a lipo only breast reduction awake, and I was like, there’s no way this is going to go well. And she didn’t even flinch. And I was like, oh, okay. But then you do a really, really small area of lipo on somebody and it’s like the world is ending and I’m like,
Dr. G (33:49):
I know. I think they just have to be motivated and it’s not financially motivated to do it.
Bri (33:56):
Yes,
Dr. G (33:56):
Motivated and know that they have a really great pain tolerance. I mean, one of the ways we check that is when you go to the dentist, how does it go? And people who are like, oh, I have no issues, or I have to get numbed a million times to get it really numb, that’s a no go. That’s a good screening. My friend does breast reductions under local. I think we’re probably going to offer breast augmentation under local.
Bri (34:21):
I’m just waiting for that one. I can’t wait to see it.
Dr. G (34:25):
I think you can get the breast really numb. So once again, it’s all about the patient being comfortable with what’s happening, but I think we have a good track record of doing things under local. Just again, it depends on the procedure and I feel like labiaplasty, we could do with our eyes closed, it’s absolutely the easiest to do. And then bleph maybe next and some other little things.
Bri (34:48):
Blephs are easy, the eyes numb, super well, ears numb.
Dr. G (34:51):
I’ve done otoplasty under local also fairly easy. Any who? So when someone’s awake, what are they doing? Are we talking to ’em or?
Bri (35:02):
Yeah, so a lot of procedures, you can come in, you can either hang out, you can watch a show, you can put on your headphones depending on the area. Of course if it’s breast or something, you have to put your arms out so you can’t be on your phone. But labia plasty podcasts, you can chitchat with us. We have some, I know our conversation on the podcast is great, but the riveting conversation in the OR is just super great. I think we go on some really good tangents. We do. We like a lot of gossip. So
Dr. G (35:34):
Let the patient lead the conversation generally speaking.
Bri (35:37):
Yes. We get some really good information on. They have great stories.
Dr. G (35:42):
Yes, I agree with that.
Bri (35:44):
Chitchat, hang out.
Dr. G (35:45):
Listen to music. We can play music or you can listen to music on your phones if you bring ’em.
Bri (35:51):
Yes.
Dr. G (35:52):
I would say we’re probably not the best DJs, but I feel like Spotify does us dirty.
Bri (35:57):
It does. It’s rogue. It is. You’ll put on a playlist and it’ll all of a sudden go from, I don’t know, for example, Kendrick Lamar if you want some hip hop or whatever that is. And then it segues into a cue of Christmas, Meow, meow, Taylor Swift. And we’re like, what on earth?
Dr. G (36:15):
I know Taylor Swift is in every playlist, no matter what you put ludicrous radio on for him, there’s a Taylor Swift song. I like hate us.
Bri (36:22):
It hears me talk about how much I hate Taylor Swift. It’s not a hatred. I just do not like her music. And I swear it puts it on every third song. It’s like this is what you get for talking crop about Taylor Swift. So local is you can do a lot of things under local. What other procedures have we done under local? I’m trying to think. I think we asked you were going to say something or no. No. Okay. I was going to segue and ask the recovery period for or not being under local versus going under general.
Dr. G (36:57):
So that’s a double-edged sword. Your recovery period’s faster from a grogginess standpoint. Obviously you didn’t have a general anesthetic, but does that mean you can go work out the next day? Absolutely not. I just want to say that again. No,
Bri (37:12):
That’s what people, okay. That is another thing is people feel usually so good after they’re like, oh, well, I’m just going to do it. I feel fine. Don’t do it. Just don’t.
Dr. G (37:22):
So you’re still healing from wherever we operated on and you still need to take it easy for generally speaking, two weeks. So yeah, I kind of want to get my upper eyelids done, but every time I think about doing it and I have to take two weeks off from working out, I’m like,
Bri (37:36):
She’s the worst. She won’t even take one night off after Botox or something. You’re not supposed to work out. And she’s like, well,
Dr. G (37:43):
I need to have some reason to slow me down so that I can do something because I know
Bri (37:50):
Sedate her for two weeks.
Dr. G (37:51):
Put me in a medically induced coma and then I can get everything done. I want.
Bri (37:57):
Her version of the things she does in a day is just different than any other human I’ve ever met. Her 24 hours is not the same as my 24 hours. The thing she does. I’m like, wait, what? It is kind of insane. I don’t know if you’re just cracked out every day.
Dr. G (38:16):
I’m not.
Bri (38:18):
I’m barely functioning. And she’s like, oh, I’ve already done this and this. Taken 50 kids to school, done a yoga class, read, took a beach walk. I’m like, it’s like 7:00 AM
Dr. G (38:28):
Right? Yeah. I like to keep moving. I guess. Every once in a while it catches up with me.
Bri (38:33):
Are there any, you
Dr. G (38:35):
First jinx, you
Bri (38:36):
You owe me a spin drift. Okay. So are there any certain medical conditions or health history that would steer someone away from having journal anesthetic?
Dr. G (38:46):
Absolutely. So yes,
Bri (38:49):
Malignant Hypothermia.
Dr. G (38:50):
For sure. Malignant hyperthermia, which is super rare, but you can’t have a general anesthetic. Yeah, I think if you have multiple medical problems, it is somewhat safer for you to go under a local anesthesia. But if you really can only do local anesthesia, then we have to be thinking about how safe you are for an elective procedure in the first place. So I guess it kind of depends on what it’s, yeah, right. It’s true.
(39:16):
And then can you drive yourself home? Absolutely. If you just strict stay with just strict local anesthetic. If you take an oral sedative, no, you need a ride home. And our oral sedative of choice is MKO, which stands for Midazolam, which is versed. So that’s the one that makes you lose track of time and it’s kind of anti-anxiety. Ketamine, which is ketamine, and then Zofran, which is anti-nausea medication. So that combination works really well. We usually give people two unless they’re teeny tiny, then we give them one. It’s sublingual, it kicks in about 15 minutes and it’s pretty good effective, but you’re still kind of loopy. For some people it hits really hard. So I usually mark them before we give it to ’em because otherwise I don’t know how fast it’s going to kick in. And then for some people it barely dents. I mean they get some effect, but they’re still pretty awake, like I said, ready to go to the club and are feeling pretty good. Either way you need a ride home. Okay. And then awake, but comfortable. Are patients aware of what’s happening? Absolutely. Yeah. You know what’s going on? It’s just if you take the oral sedative, like I said, you lose track of time and you forget. Sometimes you’ll ask me a question and then you’ll ask the same question again, even if it’s nothing like, Hey, are you taking any vacations anytime soon? And I’ll be like, oh yeah, we’re planning this or that. And then half an hour later, Hey, are you taking any vacations? And they’re like, I don’t think it’s working. And I’m like, no, it’s working. You just asked me the same question four times .
Bri (40:49):
When you keep asking for another one, it’s working. But yeah, super easy. You have no iv, it’s not like you’re not being monitored.
Dr. G (40:59):
So because of that, tips are to make sure it’s not like a regular general anesthetic where you can’t eat anything after midnight and you’re not supposed to just drink maybe a little bit of water. You should absolutely not show up on an empty stomach for this. We want you to have eaten a breakfast or lunch or whatever and be hydrated. And that makes everything go smoother too. Being hungry is not helpful when you’re doing something under a local anesthetic. And my friend that does really pretty long procedures under a local anesthetic gives patients bathroom breaks and breaks. It’s a pain in the butt from a prepping standpoint because she re preps ’em. But she’ll often do most of the surgery or half of the surgery and then let them sit up and take a look at it and then they go get a cracker and then they go pee and then they come back and they re-prep and they do the other side. I don’t know,
Bri (41:50):
I think it just makes sterility super hard, at least coming from my standpoint. I know, because then you’re worried and then are you scrubbing out? Where is the mail? Everything is just, I agree. I don’t love that personally as the person that would have to re prep.
Dr. G (42:08):
Re prep. Yeah, I know. I think it’s,
Bri (42:11):
And are you bleeding on the floor? I remember what is, you know what I mean? You’re oozing a little bit.
Dr. G (42:18):
I kind of want to go visit her and see what happens, but then that means I have to fly to Florida and less excited about that.
Bri (42:24):
Oh, I’ve never been to Florida. I’ll be at the beach.
Dr. G (42:27):
You might be disappointed. But yeah, so we could go take a road trip to Tampa and check all that out. But yeah, I think the re prepping all of that is a little bit tough. And we just had a pretty good lecture about different things that you can do in the OR to prevent infection. One of ’em is keeping the room relatively warm, not super cold. I’m like, check because a patient being cold is a risk factor for a post-op surgical infection. And that is one thing that Dr. Gruber actually does too, is their room is warm because they’re getting a full standing, full body prep. But then the other thing is not having a bunch of staff turnover, which I think is a common thing in the hospital where people are constantly giving the scrub tech a break and the nurse a break and then there’s a lunch break and then there’s another break.
Bri (43:16):
It’s just me. So that definitely we don’t have that issue. But yeah, I feel like it lends itself to that, who’s walking out with the patient and walking back in and all that traffic. But she has it locked down, so that’s great. I’m sure she’s super careful about sterility. I know from briefly doing per diem work at one of those places where they do awake lipo, just mostly out of curiosity that their version of sterility is completely different. There’s no gowning up and it was kind of just because you can get away with it doesn’t mean you should. I guess that freaked me out. I was constantly, I need another pair of gloves, I need another pair of gloves because I don’t like what, what’s happening. So let’s see. Any other, anything not safe or practical with just local anesthetic? I be, anytime we lip a more than one body part. I think my friend does tummy tucks under local. I don’t recommend.
(44:21):
No, we’re going to have to talk more about that. Yeah, no. Is there a diastasis repair with that? No. That would be so painful under local. I know no one would get through that.
Dr. G (44:34):
No, I don’t recommend a thigh lift under local either.
Bri (44:37):
I don’t want to be present for anything under local for thigh lift related. I already love our thigh lifts, but that’s just brutal. Envisioning an awake patient. Yeah, they would not be comfortable. No, we would not be comfortable.
Dr. G (44:55):
But yeah, I think
Bri (44:57):
And all the swearing I do in that procedure, no one would be comfortable.
Dr. G (45:02):
Right. I mean, just having to listen to us chit chat. So, alright, well we are going to wrap that up. So local anesthesia is not a no. It’s often a yes, but there are caveats that would be the moral of the story. So if you have a question about it, let us know. If you’re thinking about doing a procedure under local, absolutely reach out. If you want to hear more about any of the procedures we mentioned, leave a note in the comments, I guess.
Bri (45:31):
Yeah, love to hear it.
Dr. G (45:32):
Scrubbing in.
Bri (45:33):
And scrubbing out.
Dr. G (45:38):
If you’re listening today and have questions, need info about scheduling, financing, reviews or photos, check out the show notes for links. Restore SD plastic Surgery is located in La Jolla, California. To learn more about us go to restoresdplasticsurgery.com or follow us on Instagram @restoreSDplasticsurgery. If you enjoyed this episode, please share it and subscribe to All the B’s on YouTube, apple Podcasts, Spotify, or wherever you like to listen to podcasts.
About Restore SD & Dr. Katerina Gallus
As the Director of Restore SD Plastic Surgery, board certified female San Diego plastic surgeon Dr. Katerina Gallus has over 20 years of experience helping patients enjoy head to toe rejuvenation with face, breast and body procedures. After a successful career as a Navy plastic surgeon, Dr. Gallus founded her San Diego plastic surgery center, Restore SD Plastic Surgery, with the intention of creating a welcoming space for anyone seeking cosmetic enhancement.
Restore SD Plastic Surgery offers popular facial rejuvenation procedures like facelift & neck lift, facial fat transfer, nanofat grafting and rhinoplasty; breast augmentation with implants, breast lifts or breast reduction; body contouring procedures such as tummy tuck, liposuction, mommy makeover, and Brazilian butt lift (BBL), as well as non-surgical aesthetician services, BOTOX, dermal fillers, laser treatments, and weight loss injections.
Dr. Gallus and her highly-experienced aesthetics team are here to help you look and feel your best! To schedule a personal consultation, please contact us online or call our office at (858) 224-2281 today. We proudly serve the San Diego and La Jolla areas.
Leave a Reply