Most adverse outcomes in Korean cosmetic surgery — the rare ones that make international news — are not surgical complications. They are anesthesia events in offices that cut corners on monitoring or staffing. The good news: every one of those corners is visible to a patient who knows what to ask.
This FAQ is the questions list. Bring it to your consultation.
What kinds of anesthesia are used in Korean cosmetic surgery?
- Local anesthesia: only the surgical area is numbed. Used for many filler, botox, mole removal, and small procedures.
- Sedation (twilight) with monitoring: the patient is in a light sleep but breathing on their own. Common for double-eyelid surgery, light rhinoplasty work, and thread lifts.
- General anesthesia: full unconsciousness, with airway management. Required for major procedures: rhinoplasty with rib cartilage, breast surgery, V-line surgery, liposuction over a threshold volume.
What is propofol and why does it matter?
Propofol is the most commonly used sedation drug in Korean cosmetic clinics. It is short-acting, predictable, and produces the comfortable "twilight" state most patients describe as easier than general anesthesia. It is also the drug most often linked to anesthesia-related fatalities in cosmetic settings.
The reason: propofol can rapidly suppress breathing. In the wrong dose, with poor monitoring, the patient stops breathing minutes before anyone notices. Korean Society of Anesthesiologists guidelines have recommended for years that propofol sedation be performed under direct anesthesiologist supervision, but enforcement varies clinic to clinic.
What should I require for any procedure under sedation or general?
- A board-certified anesthesiologist (마취과 전문의) personally administering and monitoring — not a nurse or surgeon doing both jobs.
- Continuous monitoring of: heart rate, blood pressure, ECG, pulse oximetry, end-tidal CO2 (capnography), and temperature for longer cases.
- Resuscitation equipment on-site: defibrillator, intubation kit, emergency drugs.
- A formal transfer agreement with a nearby tertiary hospital.
- For longer cases (>2 hours general anesthesia): an in-house ICU or rapid hospital transfer plan.
What questions should I literally ask the clinic?
Verbatim, in order:
- "Will a board-certified anesthesiologist be in the operating room for the entire procedure?"
- "What is their name, and can I see their license?"
- "What monitoring will be used? Do you use capnography for sedation cases?"
- "Where is the nearest hospital, and what is the transfer protocol?"
- "How many hours of sedation experience does the anesthesiologist have on this specific procedure?"
- "Is the operating room equipped with CCTV, and can I request the recording afterward?"
Reputable clinics will answer these immediately and without irritation. Discomfort with the questions is itself an answer.
What is the CCTV-in-OR law?
Korea passed legislation requiring CCTV recording in operating rooms for patients under general anesthesia. Enforcement and clinic compliance vary, and the patient typically must request recording in advance. The law was driven in part by historical concerns about "ghost surgery" — where a different surgeon than the one consulted performed the actual procedure. If you are having major surgery, request CCTV recording in writing as part of your consent.
Are smaller, day-surgery clinics safe for general anesthesia?
They can be — if they meet the standards above. Many excellent surgeons operate from outpatient clinics with full anesthesia coverage. The risk profile rises sharply when:
- The clinic uses propofol sedation without a dedicated anesthesiologist.
- Capnography is not used during sedation cases.
- There is no clear transfer arrangement with a hospital.
- The clinic's history includes serious adverse events, especially repeated ones.
How can I check a doctor's license or specialty?
Korea's Health Insurance Review and Assessment Service (HIRA) and the Ministry of Health and Welfare maintain public lookups for licensed practitioners and specialty board certification. KHIDI's medical-tourism program also lists registered providers with verified credentials. Ask the clinic for the specific surgeon's license number; they should be willing to provide it.
What about "ghost surgery"?
Ghost surgery — a different doctor than the one you consulted with performing the surgery — is the issue CCTV legislation was designed to address. Defenses you can take:
- Confirm the surgeon's name in writing on your operative consent.
- Request CCTV recording.
- Photograph (politely) your surgeon meeting you in the OR before sedation begins.
- Use the AskGangnam community to verify whether the clinic has any history of substituted surgeons.
I have a chronic condition. What do I need to disclose?
Everything. Anesthesia is the part of cosmetic surgery where hidden facts cause harm.
- All current medications (including supplements and birth control).
- Any history of asthma, heart disease, sleep apnea, or seizures.
- Personal or family history of anesthesia complications.
- Recent illness or upper-respiratory infection — even a cold can change your safety profile for general anesthesia.
Is it normal to have pre-op blood work?
Yes. For any procedure under general anesthesia, expect a complete blood count, basic metabolic panel, coagulation studies, and ECG. For older patients or longer surgeries, add chest X-ray and additional cardiac evaluation. A clinic that skips pre-op labs for major surgery is cutting a corner you do not want them cutting.
Bottom line
Anesthesia is the silent part of plastic surgery. It is also the part where patient questions have the biggest impact on safety — clinics that meet a high standard are happy to demonstrate it, and clinics that don't will reveal themselves quickly. Ask the questions. Walk away from incomplete answers.