Dr. Anil K. Gandhi, who performs both awake procedures at his office in Cerritos, Calif., said he had taught “more than 100 doctors” in two-day $7,000 seminars for the National Society of Cosmetic Physicians. His students are doctors who typically did their residencies in ob/gyn or family medicine and who take a weekend course (or two) to learn how to do aesthetic surgeries with local anesthesia and sedation.

This shortcut to practicing aesthetic surgery tends to outrage the traditionalists. After all, board-certified plastic surgeons spend five to eight years after medical school learning operations and then have their surgical skills vetted in exams.

“Two-day courses, it’s just crazy,” said Dr. William P. Adams Jr., a plastic surgeon in Dallas who teaches residents at the University of Texas Southwestern Medical Center. “It took us six years to fully train plastic surgeons to do breast augmentation.” He said it was irresponsible to let fuzzy-headed patients choose their implants. “They don’t let people drive after a six-pack of beers,” said Dr. Adams, who is an investigator for Mentor and Allergan, makers of breast implants (and a consultant for Allergan). “How well will people choose an implant size after narcotics?”

Dr. Adams and other plastic surgeons say that mid-surgery consultations can be harmful if the patient chooses implants too large for her chest. Overaugmentation can produce unsightly rippling, said Dr. Mark L. Jewell, a plastic surgeon who does breast augmentations with local anesthesia and intravenous sedation in an accredited facility in Eugene, Ore. “Decisions should be made ahead of time,” said Dr. Jewell, an investigator for Mentor and Allergan as well as a consultant for Allergan.

Several doctors said that promoting local anesthesia and sedation for aesthetic surgeries was just a gimmick that played down the risks. “Promotion of these surgeries as so easy that only local anesthesia is required, it’s intended to make someone think, ‘It’s not serious,’ “ said Dr. Douglas R. Blake, an anesthesiologist in Providence, R.I., who specializes in office-based procedures. “The promise to get by with just local anesthesia may in fact be shortchanging the patient.” Say a patient feels faint, or has a panic attack mid-surgery, “who’s there to attend to the patient?” he asked.

Practitioners of awake breast augmentation offer patients sedation and then pump in a numbing fluid. This liquid — which has been used for years in a kind of liposuction called “tumescent” — includes lidocaine, an anesthetic, and epinephrine, which controls bleeding.