Pain Management and Aesthetic (Cosmetic) Surgery

York, NY (January 15, 2003) — Ask any surgeon
what single question patients most often
ask prior to undergoing a surgical procedure,
and chances are it's "How much will
it hurt?" Many aesthetic (cosmetic)
surgical procedures cause little or no postoperative
pain; but a few can produce short-term acute
discomfort. Doctors want every surgery to
be as painless as possible, and pain management
is now recognized as a vital part of the
surgical experience.

"Pain management is one of the most
important aspects of patient care,"
says plastic surgeon Laurie Casas, MD, who
chairs the Communications Commission of
the American Society for Aesthetic
Plastic Surgery (ASAPS)
. "One
very important issue doctors face is how
to take away the pain without causing negative

In a recent issue of Aesthetic Surgery
Journal, ASAPS' peer-reviewed
clinical journal, Dr. Casas and plastic
surgeon Mark Jewell, MD, outline guidelines
for addressing pain management after ambulatory
cosmetic plastic surgery. Drs. Casas and
Jewell emphasize the importance of educating
patients about what to expect following
surgery and about monitoring patient comfort
throughout the immediate postoperative period.

Major advances in pain management techniques,
and an evolution in products, now provide
significant relief to cosmetic surgery patients
and give surgeons a greater variety of options
for patient care:

  • Controlled and continuous infusion of
    local anesthesia to the surgical site with
    the use of Pain Pumps offers pain control
    for up to three days. Dr. Casas say that
    this protocol, in use since 2001, has been
    found to dramatically decrease postoperative
    pain and the reliance on narcotics.
  • For regional pain management in procedures
    such as breast augmentation and abdominoplasty,
    large area local anesthesia (LALA) is very
    effective. This protocol has been successfully
    used by doctors for over 70 years, and has
    been modified over time for increased efficacy.
  • Cox-2 inhibitors, such as Celebrex and
    Vioxx, can be used before and after surgery.
    Cox-2 inhibitors control systemic pain without
    causing bleeding (a common side-effect of
    ibuprofen, aspirin and naproxen).
  • Oral opioid combinations, such as acetaminophen
    and codeine, for immediate postoperative
    pain control are still utilized. However,
    these are known to have certain negative
    side effects.

"Sometimes the side-effects from a
pain management protocol are worse

than the pain from the surgery," says
Dr. Casas. "All doctors strive to give
their patients the best outcome with the
least amount of pain possible."

In the long run most patients focus on
the positive outcome of the surgery, not
any discomfort involved. Dr. Casas notes
that she regularly hears her patients tell
prospective patients how pleased they are
with their decision to have surgery, that
there was not much pain, and they only regret
they didn't do it sooner. "Effective
pain management contributes greatly to overall
patient satisfaction with cosmetic surgery,"
says Dr. Casas. "As patient advocates,
plastic surgeons see it as intrinsic to
the surgical experience."


The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world's leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body. ASAPS is comprised of over 2,600 Plastic Surgeons; Active Members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and nonsurgical aesthetic procedures. International Active Members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.


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