With more surgical procedures than ever before being performed in office settings, office-based anesthesia is a rapidly growing area of anesthesia practice. Although there are many advantages to office-based practice, limitations inherent to this setting, if not recognized and addressed, may threaten patient safety. The demand for cosmetic surgery is considered one of the driving factors in the exponential growth of office-based anesthesia. Anesthesia for cosmetic surgery procedures in the office setting is frequently performed under monitored anesthesia care (MAC) with its own unique safety considerations. Anesthetists practicing in office-based cosmetic surgery practices must understand the special characteristics of this setting, the MAC-based approach often used, the anesthesia and safety considerations for the cosmetic surgical procedures performed, and the importance of prophylaxis for venous thromboembolism.