Facelifts can be performed under general anesthesia or local and IV sedation

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.

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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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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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.

Follow the link for more information:  http://www.drhoenig.com/press1.html

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