Awake Face Lift - Local Anesthesia Option

I routinely do full face lifts with local anesthesia and oral sedation. It is not just for mini facelifts. You are given enough oral medication to make you sleepy and relaxed, plus injections of local anesthesia so you feel no pain. Sometimes, I'll give an injection in the muscle to further relax you. (For those who prefer IV sedation, that is also an option.)

I have been doing facelifts with local anesthesia for 8 or 9 years now and the patients love it beacuse of the quicker recovery, safety profile, less nausea, plus some people just don't want to "go under". Bruce Hensel did a story on NBC in 2003 on my technique, The Awake Facelift. It  can be combined with eyelid surgery, fat transfer etc.

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Almost all modern facelifts are performed with local anesthesia. The question then is only what sedation you administer in addition to the local anesthetic, and who administers it. The options are no sedation, oral sedation alone (i.e. valium), deep intravenous sedation, or a light general anesthetic.

When the airway may be compromised, for example by bleeding during surgery, or in a patient with reflux disease, it is usually better to have the patient asleep with a tube protecting their airway.

In our practice, when a deep intravenous sedation or light general anesthetic are administered, these are performed by a board certified anesthesiologist (not the surgeon pushing drugs on his own) in an accredited outpatient surgery center or hospital.

For mini-lift type procedures in a compliant patient, a local anesthetic may be fine. For a patient having a full facelift with many ancillary procedures, deep sedation or a light general anesthetic may be preferable. Your doctor should be able to discuss with you all the options above. And remember, safety first!

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Having used both techniques for more than 30 years I only use local anesthesia for the following patient: 1. patients who only require a" minilift " and the idea of surgery does not make them anxious. 2. Patients who medically cannot have general anesthesia, but can have local anesthesia. In these patients I always have an anesthetist to give IV medication to make the injections totally without pain. 3. Someone who absolutely refuses general anesthesia because of fear.

For all other patients, I use intubation or LMA anesthesia. It is very rare with our type of general anesthesia to have nausea or prolonged recovery. This gives us the best of all worlds. The patient has absolutely no pain, awareness of surgical sounds, and for longer surgeries is much more comfortable than with local. As for safety, in more than 30 years of doing this we have never had any anesthesia problem requiring the patient to receive hospitalization or serious problem. Doctors who use all types of anesthesia in their office will be better able to tailor each patient to the best one for each. Beware of the setting where the doctor only does local anesthesia because sometimes the doctor cannot get qualified anesthesia providers to give their anesthesia.

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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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