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What Type of Anesthesia is Available for a Mini-facelift or S-lift?

why do some doctors do mini or s-lifts with local and others more asleep anesthesia?

Doctor Answers 39

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,

David Hansen,MD

Beverly Hills Dermatologic Surgeon
5.0 out of 5 stars 31 reviews

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.

Jonathan Hoenig, MD
Beverly Hills Oculoplastic Surgeon
5.0 out of 5 stars 38 reviews

Anesthesia for a Mini-Facelift

Hi and thanks for your question.  I offer both local and general.  There are advantages and disadvantages to each.  Local anesthesia avoids the expense of an anesthesiologist and the surgicenter fee, but there is some pain involved with the local anesthesia injections.  Once the injections are completed, there is no pain at all.  General anesthesia avoids the pain associated with the injections, but there is a very,very small risk associated with going to sleep.  Some patients have personality types that make them good candidates for local anesthesia and some for general anesthesia. I give my local anesthesia patients Ativan before surgery to relax them, but surgery can still be stressful.

Jonathan Pontell, MD, FACS
Philadelphia Facial Plastic Surgeon
5.0 out of 5 stars 72 reviews

Anesthesia for cosmetic procedures

This is a great question, as there are multiple options available for anesthesia during elective cosmetic procedures. What it boils down to, or should boil down to, is patient safety, comfort, and last: surgeon preference and comfort, which definitely plays some role.

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.

Cameron Chesnut, MD, FAAD, FACMS, FASDS
Spokane Dermatologic Surgeon
5.0 out of 5 stars 16 reviews

Anesthesia for Mini-Lift or S-Lift

Thank you for this great question. In my practice, this is a choice given to the patient. Local anesthesia is appropriate for patients having shorter procedures and those with good pain tolerance. Sedation is the most common option, and involves some medications to make you sleepy and control pain, but does not require a breathing tube. Finally, a small percentage of patients will request general anesthesia in order to be completely asleep for the surgery. As a final note, your overall health should be taken into account when making this selection and also when deciding on the appropriate setting for the procedures (office, surgery center, or hospital). Best of luck!

Evan Ransom, MD
Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 71 reviews

Mini facelifts under local anesthesia

Thanks for posting your question. I have performed thousands of facelifts, neck lifts, mini lifts, blephs, lasers and chin implants all under local anesthesia and oral sedation (valium). Done properly, patients are comfortable and have an easier recovery both mentally and physically. There is an art and science to this local anesthesia technique to acquire a high level of patient comfort. My patients do not even require a narcotic prior or during their their procedures thus reducing nausea caused by narcotics. The risks, both short term and long term, of general anesthesia are eliminated. Please consult with several board certified surgeons experienced in facelifting and also in local anesthesia techniques.

Raymond E. Lee, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 45 reviews

Mini lift anesthesia

The type of anesthesia used for a mini-lift procedure is usually based on surgeon preference and patient desire.  Some patients desire to be completely asleep, while other want to be fully awake.  All types of anesthesia are very safe.  If cost is a factor, local anesthesia with or without oral sedation is cheaper than general anesthesia because the Anesthesiologist's fees are removed from the equation.

Clyde Mathison, MD
Knoxville Otolaryngologist
5.0 out of 5 stars 5 reviews

Mini lift vs. Ulthera

Mini lifts are performed under local, conscious, and general anesthesia. Another option which is idea is the Ultherapy lift for the neck and face that has minimal downtime and requires no anesthesia.

Dr. Karamanoukian

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 70 reviews

Anesthesia for facial surgery

I do for my patients what I would want for my family or myself, a board-certified anesthesiologist provides anesthesia care. In my surgery center, a board-certified anesthesiologist remains at the bedside of the patient throughout their surgical procedure.  Patients are safest, most comfortable, and it makes it much easier for me to provide the best result possible

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.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
5.0 out of 5 stars 70 reviews

Anesthesia facial plastic surgery

 Every surgeon has the prefer way to perform surgery.  Is not  a matter of safety  is more a matter of personal preference that you should  discuss  with your surgeon.  I persoallly prefer sedation and local anesthesia

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.