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IV Sedation and Local Anesthesia Safe Option for Facelift?

I realise that the purely medical risks are less than general anesthesia, but isn't sedation risky in terms of a possibility, however small, for the patient to actually wake up mid-operation? Or of reaction to the sedation (e.g. restlessness) while actually being operated on? It sounds slightly scary to be semi-conscious during a lengthy, hours long procedure for a facelift. What is your advice, please?

Doctor Answers (14)

Anesthesia options for facelift


I always offer my patients either General Anesthesia or Monitored Anesthesia Care, both with Board Certified Anesthesiology providers, as options for their facelifts. If they do not express a preference, I prefer MAC as the absence of an endotracheal tube certainly expedites the necklift portion. In my practice, I am fortunate to work with exceptionally talented anesthesiologists who "dose" the IV sedation using the usual noninvasive monitors, (blood pressure, electrocardiogram, pulse oximetry). They also use the BIS (brain wave) monitors, which allow them to ensure two important outcomes, namely that patients do not have intraoperative recall (remember painful or frightening events) and have rapid emergence (i.e. wake up smoothly, without nausea) at the end of the case. We have a general anesthesia machine and airway kit but have never had the need to use them.

Patient selection is crucial, as patients should not be "sold" on a technique, rather accept it after full disclosure.Even before the patient arrives, we discuss the operative experience, so they are fully prepared. On arrival, they receive pre-meds, which dove tail into what the anesthesiologists provide. I supplement with local anesthesia +/- nerve blocks, predicated on the patient's weight. Our post-op surveys document safe outcomes and patient appreciation for less intrusive methods. Ultimately, it does depend on matching the patient's needs, the procedure planned and the surgical/anesthesia team. Hope this helps. Good luck.

Orange County Plastic Surgeon
5.0 out of 5 stars 40 reviews

It depends on the surgeon and the surgery.


We do all of our regular facelifts under general anesthesia combined with local. In that way the depth of anesthesia needs to be much less. We also like to be able to control the airway.

For mini lifts in some patients, I will do them strictly under local after they have taken oral valium. If I use IV anesthesia I ALWAYS have it done by an anesthetist since I only want to focus on my job, not two.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 16 reviews

General anesthesia is preferred and is more comfortable for patients


Respiratory depression and respiratory arrest can occur when patients are partially awake and partially asleep. It is actually safer to be asleep under general anesthesia with a board-certified physician anesthesiologist than it is to be half asleep and half awake. Patient awareness and consciousness of what is going on is a very real issue, so the safest option is to be put to sleep under general anesthetic.

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 58 reviews

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I.V. sedation is my prefered technique for both reasons of safety and comfort


Virtually all my facelifts for the past 15 years have been done with i.v. sedation and local anesthesia.

There are major advantages:

  • Safer throught the procedure
  • very nfrequent nausea afterward
  • You have the local anesthesia in your tissues so that when the operation is complete there is less pain
  • No distortion of the face from the tubes or masks needed for general anesthesia

Nathan Mayl, MD
Fort Lauderdale Plastic Surgeon
4.5 out of 5 stars 7 reviews

Anesthesia depends on the comfort of your surgeon


Dear Jacqui

It is certainly possible to perform a facelift under IV sedation. It is also possible to perform a facelift under just local anesthetic. The choice of anesthetic usually is determined by what the surgeon and anesthesiologist are comfortable with rather than any scientifically mandated requirement.

Surgeons often prefer general anesthesia because it eliminates subjective concerns of the patient. The surgeon is free to do whatever they need to during surgery because patient discomfort is largely out of the equation.

Anesthesiologists prefer general anesthesia because the airway is secure and the anesthesia machine can be used to significantly control and reduce the potential for human errors.

A facelift performed under IV sedation, for the most part, is considered a general anesthesia by the anesthesiologists. They have to work much harder to maintain the appropriate level of anesthesia. Too deep, and they need to step in and ventilate the patient; too light and the patient will begin to shift around.

To my thinking there are advantages to run a case this way but it is an art and it requires a willing artist. Many anesthesiologists seem to ADD and lack the attentiveness to run a case this way. In my experience, nurse anesthetists are much better at this skill.

I perform a number of facelifts in my office under local anesthetic and an oral valium. I have carefully screened these people ahead of time. Generally I have performed prior eyelid surgery on them in the office so I know they will be OK hearing things and can hold still the time it takes to perform surgery. The great advantage of this is minimal drugs in the system so you are not hung over by the anesthesia.

I encourage you to discuss these issues with your doctor. If nothing else, it is a test for how flexible and open your doctor is, which is a good trait to have in a surgeon.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 17 reviews

Anesthesia used will vary from Patient to Patient and Surgeon to Surgeon


Hello Jaqui,

Your question is a very good one and one that I discuss with my patients every day.

General anesthesia, IV sedation and local anesthesia all have their advantages and disadvantages. They are all options worth considering and ultimately the the method used is arrived at by weighing all the important factors in play : safety first, the type of facelift being done, the Patient's medical health and history, the Surgeon's comfort level, the Patient's comfort level, the number and type of additional procedures being done, the setting where the procedure is being done (ie. hospital vs. office based), etc.

I have some Patients who insist on local anesthesia and others who want to be "completely out the whole time". I am very experienced at doing facelifts without general anesthesia and it is my preferred method. However in Patient's who are not comfortable with being awake or whose anatomy requires a more strenuous procedure then certainly general anesthesia becomes a better option.

Bottom line is you should sit down with your Surgeon and go over your concerns with them so that you can both arrive at the technique that will work the best for your case. These procedures are elective and there is always time and room to make them as stress free as possible for the Patient.

Lastly an experienced anesthesiologist who has worked closely with your Surgeon in the past should be able to provide a comfortable experience for you regardless of anesthetic technique used.

Kamran Jafri, MD
New York Facial Plastic Surgeon
5.0 out of 5 stars 8 reviews

Anesthesia Used During a facelift

In my practice, a full facial rejuvenation surgery takes many hours. It includes structural fat grafting, the face and necklift itself, and often associated procedures, such as a browlift, blepharoplasty, or chin augmentation. To perform these surgeries meticulously and artistically, it absolutely requires a fully relaxed nonmoving patient. My anesthesia preference for these surgeries is deep IV sedation. Now, that being said, I think that patients having facial rejuvenation surgery should be as concerned about the person performing their anesthesia as they are about the mode of anesthesia itself. In my practice, we use board-certified MD anesthesiologists who are highly experienced in elective cosmetic surgery. The most important consideration in the operating room by far is patient safety, and I think that the board-certified MD anesthesiologist is best equipped to select the mode of anesthesia and to conduct the anesthesia. 

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 42 reviews

Anesthesia options for facelift

Facelift can generally be performed using 3 anesthesia options mainly 1) Local anesthesia with some oral sedation, 2) IV sedation with local anesthesia, 3) General anesthesia. It is best to discuss these options with your plastic surgeon. Not all plastic surgeons will be comfortable with all these options. The options available to you will depend on you and the experience of your plastic surgeon with that anesthesia option and the type of procedure. We have performed facelifts with all the options. Most of our patients prefer local with oral sedation, then IV sedation with local anesthesia, lastly general anesthesia.

Stanley Okoro, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 85 reviews

General Anesthesia vs Local Anesthesia and IV sedation


I always do my facelifts under general anesthesia but use local anesthesia in addition to allow the anesthesiologist to keep the amount of general anesthesia to a minimum. Pts are less likely to feel woosey for an extended period of time. In my opinion, the patient is comfortable and I can focus on the surgery and the outcome.

Raj S. Ambay, MD
Tampa Plastic Surgeon
4.0 out of 5 stars 15 reviews

IV Sedation with Local Anesthesia - Safe Option for Most Facelift Patients



Anesthesia Choices for Facial Aesthetic Surgery such as a mini-lift depend on several factors.
First off, I do not think the type of anesthesia influences either the recovery time or the amount of bruising. Although it is possible to do all of these procedures under local anesthesia - your comfort is the most important concern. You will have to lie still for hours and you will be aware in many cases of injections. For procedures more than 3-4 hours I would recommend IV sedation or a general anesthesia. The IV sedation for most means that you will remember little of most of the procedure and sleep for the majority of it. It is a good choice with less risks than a general anesthetic For local anesthesia cases I usually give Ativan or Valium before hand and most sleep for most of the cases without the need for an IV in healthy patients.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 47 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.