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.
