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?
Answers (3)
Patient Safety & Satisfying Results with Local Anesthesia
Hi Angie,
In my practice I perform all of my mini-lifts, S-Lifts, MACS/Short Scar Scar Facelifts and comprehensive face and neck lifts using local anesthesia (tumescent solution). Deep plane/composite facelifts, multiple combined procedures or patients with underlying medical concerns are always done with general anesthesia or IV sedation.
Over the years I have performed hundreds of facelifts with local anesthesia and have learned a few pearls along the way that help make the experience very comfortable and stress free for the patient.
Concerns of giving too much local anesthetic are mitigated by using tumescent solution (a diluted mixture of anesthetic that is very effective in managing pain) and coordinating the amount given with the patient's weight.
The injection process is made easy by providing a calm and relaxing atmosphere for the patient by taking my time and using a gentle touch. Using a very small needle and mixing some sodium bicarbonate into the anesthesia makes the whole process easy. Patience and letting adjacent areas get numb before injecting them is key.
We also have an iPod soundsystem with which the patient can select their choice of music (the Beatles are the most requested followed by soothing nature sounds). Cotton earplugs are also used for those who just want to snooze.
Oral valium is available as needed and helps calm jittery nerves that can be expected with any procedure. The majority of patients do fall asleep during the procedure even without valium. The key is a gentle touch, calm atmosphere, comfortable bed & headrest pillow.
By using local anesthesia the quality of the procedure is not sacrificed. I am able to perform all of the surgical techniques that are needed to get long lasting and natural looking results (lateral & anterior SMASectomy, cranial suspension, cheek elevation, fat pad removal, etc). that I do with sedation/general.
Lastly, while cost should never be a prohibitive variable in choosing a safe and effective procedure, by using local anesthesia a cost savings can be passed on to the patient.
Either technique is proven and acceptable: your safety comes first and satisfying results are always the goal.
Sedation is your friend and is certainly preferrable to receiving too much Lidocaine
Facial Plastic Surgeon
Remember, if you are a healthy patient.... and you should be if considering an elective cosmetic procedure.......anesthesia is actually your friend.
Why? Sedation alleviates anxiety and provides pain relief.
The form of anesthesia I provide for my patients (with a CRNA) in my AAAASF accredited facility is very similar to what one received for a colonoscopy. Before coming to the facility, the patient receives a sublingual Emend, which allows for nausea control, and 5 mg of Valium. Upon arrival, the patient is given intravenous Versed, which takes away memory of the event, and controls anxiety. Versed is a short acting intravenous medication in the same class as Valium.
Propofol is then given intravenously in oder to allow the patient to be kept in a steady state of sedation. The patient is monitored with ekg equipment and pulse oximetry to ensure that oxygen saturations are maintained. In order to prevent a patient from becoming more awake, sedation is ensured by using a continuous intravenous pump. Fentanyl, a synthetic form of narcotic, is also used for pain relief as needed. Lidocaine and/or Marcaine are then injected into the surgical sites to further ensure pain control.
The beauty of this technique is that it allows for relief of anxiety, a dual mode pain control, and does so with medications which have a negligible cardiac effects.
Why is a local approach not always desirable? Anxiety, pain, and dangers of local anesthetic overdose. In my experience, oral Valium alone is insufficient as an anxiety reliever for most mini lift patients. Although Lidocaine shots (even when buffered) provide pain relief, they tend to burn because Lidocaine has a slightly different pH than the skin. One danger (not frequently discussed) of using a local only approach is Lidocaine and/or Marcaine overdose. Marcaine toxicity is real and potentially deadly. So, there are certainly potential drawbacks to any approach and a careful, considered discussion with your surgeon is necessary prior to making a decision.
Anesthesia for a mini-facelift or s-lift
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.
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