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Anesthesia for resurfacing
Last reviewed: 04.07.2025
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Facial resurfacing is performed under topical, infiltration, regional, intravenous, or general anesthesia. Sometimes a topical anesthetic such as EMLA cream can be used for a single superficial pass of the Erbium laser. Each additional pass requires additional anesthesia. However, EMLA cream does not provide adequate anesthesia for CO2 laser resurfacing. To optimize the surgeon's ability to see the depth of treatment under local infiltration anesthesia, it is important that the anesthetic either does not contain epinephrine or has a concentration of 1:400,000 or less.
To obtain good anesthesia, it is sufficient to use a dilute solution of lidocaine (0.05%), the same as in liposuction with hypotonic infiltration, in combination with a block of the central nerves of the face. It is necessary to correctly assess the depth of grinding. If the anesthetic contains too much adrenaline, the pink color indicating penetration into the papillary dermis may not be visible. Likewise, a high concentration of adrenaline can hide pinpoint bleeding when the erbium laser penetrates the papillary layer. Local anesthesia can be supplemented with intravenous anesthesia if necessary. General anesthesia with tracheal intubation is accompanied by a greater risk of inflammation associated with the use of oxygen and the use of an intubation tube. Currently, there are metal endotracheal tubes and a foil coating for plastic tubes designed specifically for work with lasers and preventing plastic from igniting.
Prophylactic antibiotics are even more controversial. Many surgeons prescribe antibiotics before and after resurfacing to reduce the risk of bacterial infection under long-term or closed mask dressings. Others believe that antibiotic prophylaxis does not reduce the chance of postoperative infection. Doctors who use antibiotic prophylaxis often prescribe antifungal agents to their patients to prevent fungal infection under dressings.
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