why do some doctors do mini or s-lifts with local and others more asleep anesthesia?
What Type of Anesthesia is Available for a Mini-facelift or S-lift?
Doctor Answers 38
Mini Facelifts are done under local anesthesia and are much safer than general.
Mini facelifts are now done under local tumescent anesthesia and are almost painless with the great techniques of administering the local now a days. Cost is roughly $6-8500 and recovery is so much easier as well. Sincerely,
I prefer to do my face lifts with local anesthesia and...
I prefer to do my face lifts with local anesthesia and oral sedation.
Instead of sending heavy medication into the IV line to keep you asleep or sedated throughout the procedure, tumescent anesthesia uses only local anesthesia injected into the face to control pain, and Valium pills to relax you. The term "tumescent" (meaning swollen or puffy) comes from the appearance of the area immediately after injection, before the medicine is absorbed into the surrounding tissues. The medicine that is injected is a solution of saline (salt-water), epinephrine, and Lidocaine. Saline helps to separate the tissues, making the dissection less traumatic for the face. Epinephrine causes the tiny blood vessels in the area to constrict, minimizing bleeding and bruising. Lidocaine numbs the area to provide pain control, similar to what the dentist uses before filling a cavity in a tooth.
The procedure is performed without heavy medication and without a long post-operative recovery. Most patients are comfortably and safely on their way home about an hour after surgery. Since most of the medication used with tumescent anesthesia in The Awake Facelift is eliminated from the body within a few hours, there is no "hangover" effect such as is often experienced after general anesthesia. This also translates to less post operative nausea and vomiting.
Having the patient awake throughout the procedure enables the surgeon to maximize the aesthetic result with the least risk of complications. Nerve function can be continually assessed during surgery by having the patient raise the eyebrows, smile, or perform other facial expressions. Checking nerve function is critical to avoiding the rare complication of facial nerve damage, but this important precaution is impossible using general anesthesia or heavy sedation.
In some cases, patients might not be good candidates for the Awake Facelift, such as if they are tolerant to anesthetics (have a hard time getting numbed up at the dentist), take a lot of pain medications regularly, are very anxious or nervous, or have contributing medical concerns such as cardiac history. These patients are better suited for IV sedation.
Anesthesia for cosmetic procedures
I was fortunate enough to do my cosmetics training with an incredibly wide breadth of surgeons in different cosmetic specialties within the core four: dermatologic surgery, oculoplastic surgery, facial plastic surgery, and plastic surgery. During that time, I did a large number of procedures under many different types of anesthesia, and developed my preferences from there.
That being said, I prefer to do most of my cases with oral sedation and local anesthesia. This eliminates the need for general anesthesia, which often times is the most dangerous portion of the procedure, and it eliminates the long term cognitive issues with repeated bouts of general anesthesia. To boot, it allows the patient to return home immediately after the procedure to recover comfortably and safely there. There are no issues with blood pressure changes as there are after general anesthesia, which makes the postop recovery course less worrisome and less dangerous for getting a collection of blood, or hematoma.
This type of anesthesia also completely eliminates the need for an anesthesiologist. From a financial standpoint, eliminating the need for an anesthesiologist makes the cost of the procedure last daunting.
Again, you'll find multiple opinions and types of physicians doing the exact same procedure with different types of anesthesia, and this often boils down to surgeon comfort. Some surgeons just like their patients asleep. This tends to stem mostly from what their prior training was before cosmetics: someone who may have been a general surgeon or ENT and is now doing plastic surgery may prefer general anesthesia, as that is what they are comfortable with. I tend to find that the younger, more progressive and more recently trained surgeons are the ones most comfortable with local anesthetic procedures. It is interesting though, if you ask your surgeon who wants to put you under general anesthesia, it is likely that they use local anesthesia as well after you are under general already. Patients often ask, why? The answer to that is, it makes the dissection easier when you are doing a facelift or similar. I prefer to reserve general anesthesia only for when it's absolutely necessary necessary, which is not usually the case for an elective cosmetic procedure. This is not inappropriate, but general anesthesia should be justified by the procedure and safety, not surgeon comfort.
To ensure you are receiving the highest level of care, seek out a dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties.
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Beyond the issue of the person who is administering your anesthesia, the type of anesthesia really depends on what ‘facelift’ you are talking about, and what risk factors you may have for different forms of anesthesia.
A mini-facelift generally takes one to two hours and can be performed in many patients under relatively light IV sedation. The only unpleasant portion of the procedure in terms of pain is the injection of local anesthesia at the very beginning. So the IV sedation is deeper initially for local anesthetic injection, and then once the entire surgical area is numb then the IV sedation can be lightened.
A full facial rejuvenation surgical procedure (structural fat grafting, High-SMAS face and necklift, browlift, blepharoplasties, etc) may take seven to eight hours to complete. These procedures can also be performed in many patients under prolonged IV sedation, which is referred to by anesthesiologists as MAC (monitored anesthesia care) anesthesia. To have a long surgery under IV sedation, you ideally should be under the care of an experienced anesthesiologist.
By far the most important consideration from an anesthesia perspective is management (i.e. control of) a patient’s airway. If you can’t reliably provide oxygen delivery and carbon dioxide elimination, then you cannot conduct surgery safely. So experienced, board-certified anesthesiologists insist on some adequate and appropriate means of airway protection. For long IV sedation cases it is customary to pass a nasal airway (once a patient is sedated, of course) which goes in one side of the nose and into the back of the throat and helps to keep a sedated patient’s nasal airway open. It is removed before you wake up.
Some patients will experience airway obstruction when sedated and laying in supine (on your back) position. If your snore heavily, and especially if you have sleep apnea, you are likely to be one of these patients. This in one of the reasons that a good anesthesiologist asks you so many questions before they perform your anesthesia: aspects of your history provide the anesthesia MD significant insight into what to expect and what to be particularly concerned about while you are under anesthesia.
This is important to know: general anesthesia for elective cosmetic surgery, particularly longer cases, is an absolutely reasonable choice. In some patients it is the safest form of anesthesia – as your airway is completely.This is deeper level of anesthesia than IV sedation, and it requires a flexible, soft plastic tiube (either an endotracheal tube or laryngeal mask airway) to keep your airway open as the muscles that keep the airway open when you are awake will be relaxed. If you snore heavily or have sleep apnea, the safest form of anesthesia for you is general anesthesia with an ET tube or LMA.
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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.