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Cosmetic surgery: anesthesia, sedation and the questions that matter

What the evidence shows about sedation risks, the fat-grafting deaths task force, and what to ask about who gives anesthesia and where.

2 minute read8 sources, each checked word for wordLibrary checked October 18, 2026

In short

  • A task force found significantly higher death rates with gluteal fat grafting than with any other aesthetic operation.E2Good1
  • Oversedation leading to slowed breathing was an important cause of injury in sedation claims.E2Good2
  • The propofol label says it should be given only by people trained in general anesthesia who are not doing the procedure.Official text3

How sure each claim is:E1StrongE2GoodOfficial textReviewWhat the grades mean

What the fat-grafting task force found

Despite its popularity, gluteal fat grafting appears to carry significantly higher mortality than any other aesthetic surgical procedure.E2Good1

Surgeons who injected fat into the deep muscle had a significantly higher rate of fatal and nonfatal fat emboli to the lungs.E2Good1

Sedation and who gives it

In malpractice claims involving monitored anesthesia care, oversedation leading to slowed breathing was an important cause of injury. Monitoring, vigilance and early resuscitation could have prevented many injuries.E2Good2

More than 40% of those claims involved death or permanent brain damage, similar to general anesthesia claims.E2Good2

The propofol label covers who gives it for general anesthesia or MAC sedation. It says it should be given only by people trained in general anesthesia who are not involved in the procedure.Official text3

The ASA says whoever gives a level of sedation should be able to rescue a person who slips into the next deeper level.E2Good4

Local anesthetics and sleep apnea

The bupivacaine label lists early warning signs of local anesthetic toxicity, such as numbness of the lips, metallic taste, ringing in the ears and dizziness.Official text5

A regional anesthesia society notes a trend toward delayed toxicity with local infiltration techniques and continuous infusions.E2Good6

Obstructive sleep apnea is a major risk factor for problems around surgery, and the STOP-Bang questionnaire helps teams screen for it.E2Good7,8

Questions you might bring to your anesthesia team

  1. Who will give my anesthesia or sedation, and what is their training?
  2. Who watches my breathing the whole time, separate from the surgeon?
  3. Where will the surgery be done, and what rescue equipment and staff are there?
  4. If fat grafting is planned, where will the fat be injected?
  5. Will I be screened for sleep apnea, and where will I recover?

Every claim in this guide was written from its sources and checked against them word for word. Its clinical review by Dr. Recio, a practicing nurse anesthesiologist (CRNA), is pending. This line changes when the review is done.

Sources

Each source opens on PubMed, DailyMed or the publisher's page. Under each one are the exact words from it that this page relies on, copied word for word and checked against the original.

  1. Report on Mortality from Gluteal Fat Grafting: Recommendations from the ASERF Task Force. Mofid MM, Aesthet Surg J, 2017. E2Good Observational study
    The words this page rests on
    Despite the growing popularity of gluteal fat grafting, significantly higher mortality rates appear to be associated with gluteal fat grafting than with any other aesthetic surgical procedure.
    Surgeons reporting the practice of injecting into the deep muscle experienced a significantly increased incidence rate of fatal and nonfatal pulmonary fat emboli.
  2. Injury and liability associated with monitored anesthesia care: a closed claims analysis. Bhananker SM, Anesthesiology, 2006. E2Good Observational study
    The words this page rests on
    Oversedation leading to respiratory depression was an important mechanism of patient injuries during MAC. Appropriate use of monitoring, vigilance, and early resuscitation could have prevented many of these injuries.
    More than 40% of claims associated with MAC involved death or permanent brain damage, similar to general anesthesia claims.
  3. DIPRIVAN (propofol) injectable emulsion, Prescribing Information. Fresenius Kabi USA, LLC, 2025. Official text FDA label
    The words this page rests on
    For general anesthesia or monitored anesthesia care (MAC) sedation, DIPRIVAN should be administered only by persons trained in the administration of general anesthesia and not involved in the conduct of the surgical/diagnostic procedure.
  4. Statement on Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia. American Society of Anesthesiologists, 2024. E2Good Guideline
    The words this page rests on
    Individuals administering Moderate Sedation/Analgesia (“Conscious Sedation”) should be able to rescue*** patients who enter a state of Deep Sedation/Analgesia, while those administering Deep Sedation/Analgesia should be able to rescue*** patients who enter a state of General Anesthesia.
  5. MARCAINE (bupivacaine hydrochloride) and MARCAINE WITH EPINEPHRINE injection, Prescribing Information. Hospira, Inc., 2023. Official text FDA label
    The words this page rests on
    Possible early warning signs of central nervous system (CNS) toxicity are restlessness, anxiety, incoherent speech, lightheadedness, numbness and tingling of the mouth and lips, metallic taste, tinnitus, dizziness, blurred vision, tremors, twitching, CNS depression, or drowsiness.
  6. The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity: Executive Summary 2017. Neal JM, Reg Anesth Pain Med, 2018. E2Good Consensus statement
    The words this page rests on
    Contemporary case reports suggest a trend toward delayed presentation, which may mirror the increased use of ultrasound guidance (fewer intravascular injections), local infiltration techniques (slower systemic uptake), and continuous local anesthetic infusions. Small patient size and sarcopenia are additional factors that increase potential risk for LAST.
  7. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Chung F, Anesthesiology, 2008. E2Good Observational study
    The words this page rests on
    Obstructive sleep apnea (OSA) is a major risk factor for perioperative adverse events.
  8. High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Chung F, Br J Anaesth, 2012. E2Good Observational study
    The words this page rests on
    In the surgical population, a STOP-Bang score of 5-8 identified patients with high probability of moderate/severe OSA. The STOP-Bang score can help the healthcare team to stratify patients for unrecognized OSA, practice perioperative precautions, or triage patients for diagnosis and treatment.