Facelifts with Local Anesthesia - What is it like?

Kamran Jafri, MD

Article by
New York Facial Plastic Surgeon

Dr. Kamran Jafri

What is it like to have a Facelift with local anesthesia?

Over the last several years one of the most focused and specialized areas of my practice has involved the highly succesful performance of facelifts using local anesthesia.  Traditionally facelifts had been performed under general anesthesia or with IV sedation and local anesthesia.  As time and techniques and our knowledge of Facial Plastic Surgery advanced,  my practice increasingly evolved into utilizing local anesthesia for facelift surgery.  This shift was brought about by many factors:

1. Patients had an increasing desire to avoid general anesthesia and its potential complications

2. Patients were increasingly seeking more minimal procedures with faster recovery times

3. Continous advancement in different techniques of utilizing local anesthesia in a safe and beneficient way for the patient

4. Reduced cost of procedures by using local anesthesia without sacrificing the quality and safety of the outcomes of the procedure

To date I have performed thousands of Facial Cosmetic Surgery procedures using local anesthesia and have found it to be an extremely safe, effective and comfortable way of accomplishing my patient's goals.

A facelift under local anesthesia is not for everyone.  Some patients needs are such that multiple or more extensive surgery (ie. deep plane  or composite facelift) is required that is best performed under general anesthesia or IV sedation.  In addition, every patient's medical and surgical history must be considered when choosing this route. The correct and best option for each patient is best explored and discussed during the personal consultation process.

So the question is always asked :"What is it like to have a Facelift with local anesthesia?"

The best advice I always give is to speak directly with my patients who have gone through it - who would know better than them?

As a whole they have been very surprised with the ease of the procedure for them.  A common concern among many patients are the needles.  Will it hurt? How many injections?  To their surprise the injection process is not bad at all.  The reason for this is that we go to great efforts to create a calm and comforting atmosphere for our patients.  Everyone is welcomed and made comfortable by meeting all of the staff first.  I have made it a point to only work with employees that are mild mannered and sympathetic to my patients' needs.  Also very important is injection technique.  I use a very small needle and take my time with a gentle touch.  In addition a special mixture of local anesthesia is used so as to minimize any burning that is usually felt due to the chemical nature of the anesthetic.  Patients are encouraged to breathe easy and relax while my assistant stands by them holding their hand and being there with the patient.  All these little details combine to make the injection process smooth, relaxed and comfortable for the patient.

During the procedure itself cotton earplugs can be used for the patient or they can request music or soothing nature sounds (I personally like ocean waves and the beach) they like to be played over our iPod speaker system.  We have a large variety of music but many patients bring in their own iPods which we can setup to the system.  Some patients like to talk to my assistant during the procedure and others like to close their eyes and drift off to sleep (I would say the majority of patients fall asleep even if they hadn't planned to!).

For some patients the idea of any medical procedure does induce some anxiety.  If desired we offer oral valium prior to the procedure to help ease their nerves. 

No pain is experienced during the facelift due to the local anesthesia.  Feelings of pulling and tightness are experienced (but that is a good thing since that is the whole point of the procedure anyways!).

The procedure can take anywhere from 45 minutes to 2 hours depending on your specific needs.  The estimated time is reviewed before starting and updated as we move along so the patient knows exactly what to expect.  One of the important things I have learned over the years is to utilize special pillows and an adjustable procedure bed so that the patient's neck and back are comfortable throughout the procedure.

Cautery is used during the procedure and I have been able to use cool, circulating air to dispell the small amount of smoke that it creates.

Throughout the procedure we not only ensure patient comfort but sate their curiosity as well.   Some patients would like to know everything as we are doing it, others like to lie back comfortably with eyes closed and not have to worry about the details at all.  It is up to the patient and we comply.

After the procedure, patients are able to sit up and walk right away.  Often they will have some cool, refeshing water or a nutritious anti-oxidant drink with key vitamins that we provide.  There is no nausea, grogginess or potential breathing or urinary retention issues as with general anesthesia.  As a precaution the patient's vital signs are monitored throughout the procedure and verified again before discharge. 

Later in the day I call every patient at home to see how they are doing and to see if they have any questions.  Invariably they mention how much easier the whole process was than they expected.  Those who had a facelift in the past under general anesthesia comment on how much more they preferred the experience under local anesthesia with me.  Everyone is given my personal cell phone number and my answering service number to be used 24 hours a day if they need anything at all from me.