LIVS vs General Anesthesia for Facelift Surgery

Anesthesia techniques have improved considerably over the past decade.  The medications used are more precise in action with regards to predictability of onset and wear-off.  Both LIVS (local anesthesia with IV sedation) and General Anesthesia, performed by qualified medical personnel (MD anesthesia or CRNA) are good options for facelift patients depending on several factors (including patient preference).  Patient sex, amount of time estimated for procedure, patients medical history, history of sleep apnea,  etc all influence the choice of anesthesia to be used.

I typically approach each patients situation individually in choosing which anesthesia method should be used.

Having said that, I prefer LIVS, if appropriate, as the patients tend to recover faster post operativey, have less incidence of nausea and vomiting and have no problems with a sore throat from the tube after surgery. 

LIVS for facelifts in our office is used more frequently than General Anesthesia with excellent acceptance by the patients.

I have used both General Anesthesia as well as Monitored Anesthesia Care with excellent results.  There are advantages and disadvantages to both techniques, depending on the surgeon or patient's perspective:

The presence of either a Laryngeal Mask or Endotracheal tube ensures a secure airway for delivery of oxygen, however its placement and removal can cause a sore throat, or in the worst scenario a chipped tooth.  For patients who have heavy necks, management of the airway is a shared responsibility between the surgeon and anesthesia provider. I personally prefer not to have to struggle with it, however I always defer to patient's requests.

My cosmetic (including facelift) patients have been very well served by having their Monitored Anesthesia Care supervised by Board Certified Anesthesiologists who provide a specialized Intravenous "cocktail" of medications which produce a light hypnotic state, safeguard against post-op nausea and vomiting and are easily reversible.  The anesthesiologists monitor blood pressure, heart rate, oxygen saturation as well as brain waves, through a forehead sensor, thereby ensuring that their anesthesia is dosed specifically.  In this manner, the possiblity of intraoperative recall is nil and reversal of sedation, at the end of the case is a matter of turning off the drips.  Our patients wake up gently, without excessive "hangover", which facilitates their recovery.

Do recall that in all projects, you should ideally have options, so be your own best advocate and discuss this with your surgeon.

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Facelifts can be performed under general anesthesia or with local and IV sedation.  It is important to discuss these options with your plastic surgeon to discuss which option is best for you.  Many plastic surgeons choose either method.  Both methods are safe if you are a healthy person and have a qualified anesthesia provider.  Some surgeons prefer to use a board-certified anesthesiologist.  While other surgeons may prefer to use a nurse anesthetist. I prefer to use general anesthesia for many of my full facial rejuvenation procedures delivered by a board-certified anesthesiologist.

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