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Local Anesthetic w/Oral Sedation - Safe for Upper Eyelid and Lower Facelift Surgery?

asked 1 year ago by Carrie Anne in Stuart, FL
Latest answer by Sam Naficy, MD
Question viewed 654 times
Tags: age 55-64, anesthesia, safety, sedation

Am 55 with skin in very good condition. But have drooping upper lids and banding in neck. To have a lower face lift/platysmaplasty and upper eyelid surgery, doctor has offered me either the option of IV sedation with board certified anes. or was also told I was a candidate for just local with oral sedation, which will save me a substantial amount of money. Is there any reason not to do it this way? Is one form of anesthesia riskier than the other?

36 answers to Local Anesthetic w/Oral Sedation - Safe for Upper Eyelid and Lower Facelift Surgery?

+1

Anesthesia for Blepharoplasty and Necklift

I have had certified anes. present when doing surgery  under local just anesthesia. It is always safer to have another person to monitor you during the operation. Consider your comfort when making your decision - over the years I've had patients describe terrible experiences when they had procedures like yours done under just local anesthesia at other facilities.
Richard W. Fleming, MD

Beverly Hills Facial Plastic Surgeon

www.bevhills.com

+2

Facelift under Local Anesthesia

There are many centers that advertise Facelift under local anesthesia with different catchy names such as "weekend Facelift", "quick lift", etc. They all try to entice people with cheaper prices by not using an anesthesiologist, proper monitoring, and supervision. To me this sounds like having an airline advertising cheaper flight fairs by not having a pilot present, and telling the travelers that the plane is going to be controlled by auto-pilot with some... more
S. Sean Younai, MD

Beverly Hills Plastic Surgeon
+2

Face Lift and Eyelid Surgery under local or anesthesia

I do all of the above as well as offer general anesthesia.  I do however, carefully pick and choose which patients I will use straight local infiltartion on when performing Minimum Incision Face Lifts, Lip Augmentation and other suitable cases.  With a local, you will feel the injections, you will hear the sounds of scissors working through your tissues and you will hear the typical sounds of an OR with monitors etc.  If you are very calm by nature this should not be a problem... more
Francis R. Palmer, III, MD

Beverly Hills Facial Plastic Surgeon
+2

Facelift and Eyelid surgery under local anesthesia with sedation

Carrie Anne- I will try and address your 2 questions 1) Any reason not to use oral sedation and local anesthesia? If you feel comfortable awake and without feeling pain for an extended time period then you will do wonderfully. I use this same technique for some patients who do not want IV sedation and an anesthesiologist. Most people fall asleep during the procedure and comment later that the exerience was not at all unpleasant . 2) Is one form of anesthesia riskier? Use of IV sedation can... more
Travis L. Shaw, MD

Richmond Facial Plastic Surgeon
+2

Facelift with IV Sedation: More Comfortable

I have done hundreds of facelifts with IV Sedation, as well as with oral medication plus local anesthesia. In general, for healthy individuals with an uncomplicated medical history, the safety considerations between the two sedation approaches are not significantly different. You will find equally valid arguments on each side of the issue among experts. It is easier to keep you completely comfortable, even completely unaware of the surgery (including the injections of... more
Paul C. Zwiebel, MD

Denver Plastic Surgeon
+1

IV sedation + local is the best option for facial surrgery

Having performed thousands of facial plastic surgery operations with both general anesthesia and IV sedation I can say with confidence that IV sedation has all the advantages of general anesthesia (patient comfort) and very few of the side effects of general. The main advantages of IV sedation anesthesia are: It does not require putting a breathing tube in the throat It does not require a breathing machine The recovery is much faster There is much less... more
Sam Naficy, MD

Seattle Facial Plastic Surgeon
+1

Face Lift

We do all of our facelifts under oral sedation, oral block and local infiltration. In the past, we have used general anesthesia, but there is a substantial increase in post op swelling of the face, and edema of the neck. With sedation, it is decreased by about 50%, and with local, we see a reduction another 25%.
Vivek Bansal, MD

Danville Plastic Surgeon
+1

Facelift - Local Anesthetic w/Oral Sedation - Safe for Upper Eyelid and Lower Facelift Surgery?

Safe? Yes. Advisable? Maybe. There are no absolute answers with this (and many other) questions of surgery and anesthesia and you can get the same or similar results in many different ways. I offer most of the options for this procedure, including general anesthesia, intravenous sedation and, in limited cases, local anesthesia with oral sedation. I would not normally want to do the extent of surgery you're describing under local anesthesia and oral... more
Alan Engler, MD

New York Plastic Surgeon
+1

Local Anesthesia is perfect for a lower facelift and upper eyelid procedure

We have performed thousands of facelifting and eyelid procedures using oral relaxing medication and local anesthesia with a great track record of success. Even patients that say they are "needle phobic" can do very well with this technique. Most patients say the process is "easier than the dentist's office." Facelifts were originally performed under local anesthesia. With the advancement of anesthesia techniques, it became more common to put the... more
Richard Castellano, MD

Tampa Facial Plastic Surgeon
+1

Facial surgery under local anesthesia?

While it may sound like something out of science fiction or a horror novel, facial surgical procedures are commonly done under local anesthesia, often supplemented by oral medications for sedation and pain control. The face has very specific distributions of nerves that provide sensation to the skin and soft tissues, so it is very straightforward to completely numb up the entire face. It is difficult to keep the patient from hearing the surgeon work, so often an oral tranquilizer... more
William A. Wallace, MD, FACS

Jacksonville Plastic Surgeon
+1

Local anesthetic w/sedation not recommended

It is always best to have a board certified anesthesiologist in attendance during this type of surgery. While these procedures can be done under local anesthesia, it is not the most comfortable nor safest for the patient. We perform all of our procedures such as this under a general anesthesia by a board certified anesthesiologist in a Medicare certified ambulatory surgery center.
William Portuese, MD

Seattle Facial Plastic Surgeon

www.seattlefacial.com

+1

Neck lift and Blepharopalsty under local with oral sedation-safe but painful

I agree with the other doctors that saving money when considering a sophisticated surgical procedure on your face and eyes is not the best approach. Your first concern should be the skill and expertise of the Board Certified Plastic Surgeon who is operating on you. Ask the doctor which method of anesthesia he/she prefers and which will enable the Doctor to give you the best result. IV sedation and local is much much better for your comfort and the doctor than oral sedation.... more
Brooke R. Seckel, MD

Boston Plastic Surgeon

www.drseckel.com

+1

Local Anesthetic w/Oral Sedation - Safe for Upper Eyelid and Lower Facelift Surgery?

Some surgeries can be done under local anesthesia such as eyelid surgery. Face lift with eyelid surgery is a mor eextensive and time consuming surgery that should be done under sedation or general anesthesia for your comfort and surgeon's peace of mind.
Mohsen Tavoussi, MD, DO

Huntington Beach Facial Plastic Surgeon
+1

Oral Sedation vs. IV Sedation

Both oral sedation or IV sedation related anesthesia for facelift or eyelid surgery is safe. The important components of safety is to research the physician, his record, his reputation, etc. It is important to assess whether the facility or facilities that he or she suggests is an accredited facility. Also it is important to question how many surgeries the physician has performed under either of the anesthetic protocols. There are many physicians who feel that IV... more
David Q. Santos, MD

Seattle Facial Plastic Surgeon
+1

Oral sedation v. IV sedation

Am 55 with skin in very good condition. But have drooping upper lids and banding in neck. To have a lower face lift/platysmaplasty and upper eyelid surgery, doctor has offered me either the option of IV sedation with board certified anes. or was also told I was a candidate for just local with oral sedation, which will save me a substantial amount of money. Is there any reason not to do it this way? Is one form of anesthesia riskier than the other? as a disclaimer, I offer all three general... more
Rafael C. Cabrera, MD

Boca Raton Plastic Surgeon
+1

Facelift and iv sedation

For my patients, I prefer iv sedation, as opposed to oral sedation. I think that this helps to lessen anxiety, as these procedures can take time when done properly. I think you should choose based on the surgeon and see what they are most comfortable with. As long as the surgeon is safe and experienced, they should guide you to the best option.
Ryan Greene, MD, PhD

Fort Lauderdale Facial Plastic Surgeon
+1

Face Lift Anesthesia - Local, IV, or General

A face lift is not one operation, but rather many potential operations dependent on the surgeon and patient to improve neck line, jowls, and facial aging. Typically most have face lift surgery on either IV sedation (twilight anesthesia) or general anesthesia. Either are good, safe options, with their own advantages and disadvantages. Some facial plastic surgeons perform face lift surgery under local anesthesia. Anesthesia may be provided by a board-certified anesthesiologist and/or nurse... more
Houtan Chaboki, MD

Washington DC Facial Plastic Surgeon

www.potomacplasticsurgery.com

+1

Local vs sedation

I think the most important thing is what is your pain tolerance.If you are one with a low threshold then I would go with iv sedation because you don't want your blood pressure to rise during the procedure because you are uncomfortable.
Robert Brueck, MD

Fort Myers Plastic Surgeon
+1

Safe local anesthesia.

Some patients can do ok with just local and oral sedation. It's really all about the monitoring. You can have bad reactions to local anesthesia as well as general. If your surgeon is focused on operating, whose checking your breathing, EKG etc. When you think about costs, don't just think comfort, think safety, that's what you are really paying the extra for.
Michael L. Schwartz, MD

West Palm Beach Plastic Surgeon

www.palmbeachface.com

+1

Sedation is worth it!

Simply put, its worth the money to be comfortable and safe while having facial surgery.  You do not want to be awake during procedures around your eyes, even though it can easily be done. I had an RN request it for blepharoplasty, and even though the procedure went smoothly, she wished she had IV sedation as she was too aware of what was actually going on. In addition, it is wise to have an anesthetist monitoring you through out any surgery. So, spend the money--I know you won't... more
Reginald Rice, MD

Sacramento Facial Plastic Surgeon
+1

Local anesthesia v. general for facial surgery

Certainly surgery can be accomplished with either forms of anesthesia. The question is not simply can it be done, but what are the risks. If all goes well with the local, everyone is happy. But what if something like bleeding occurs, or anxiety, or restlessness, or cardiac arrhythmia. Then what? Are you going to be safe with just a surgeon and a nurse trying to contorl everything? While you can do the procedure under local, I would certainly recommend having an anesthesiologist around which... more
Robin T.W. Yuan, MD

Beverly Hills Plastic Surgeon
+1

Local anesthesia for face and eyes.

The problem here is not the patient, it is the surgeon. For the first 20 years of my career and the first 3500 facelifts I did all I.V. sedation and occasionally general anesthesia. My present approach for the past 5 years is now totally different. The experience, skill, and facility I now have let me accomplish in 1 hour, easily and painlessly, under local anesthesia what I used to do in 3-4 hours with I.V. or general anesthesia. And since 99% of the risk in facelift surgery... more
Richard Galitz, MD

Miami Facial Plastic Surgeon
+1

Oral sedation

I have made a 180 on this issue and now reserve general ( including IV anesthesia) for more difficult patients and procedures, ie laser. It has been the proliferation of injectables that has shown the surgeons and the patients how much can be acomplished with a motivated patient.  I view the safety issue to be the reverse. Even iv sedation carries a higher risk. The primary reason I was slow to change is the worst one most of us... more
J. Smythe Rich, MD

Columbia Plastic Surgeon
+1

There are major advantages in having i.v. sedation rather than just local with oral sedation.

It is not only in pain control and anxiety control that having i.v. sedation is a major advantage when the neck is opened for platysmaplasty. Patients will be become more anxious with longer procedures, especially those that they feel the tightening of the tissues.  This is particularly prevalent when the surgeon  is  leaning over their face to do the neck portion. When this occurs, their blood pressure is likely to rise.  With increasing blood pressure... more
Nathan Mayl, MD

Fort Lauderdale Plastic Surgeon
+1

Local anesthesia vs. Intravenous sedation in eyelid and facelift surgery

Either type of anesthesia can be used safely with these procedures.  The length of time it will take to perform the surgery, the extensiveness of the techniques employed, and the aversion to being sedated are all considerations in determining what type of anesthesia is chosen.  Most commonly, these procedures would be done with some type of intravenous sedation, but in patients who do not want to be sedated, oral medications with local anesthesia is effective when the procedure... more
Keith A. LaFerriere, MD

Springfield Facial Plastic Surgeon

www.facialplasticsurgeon.com

+1

Choice of anesthesia

When it comes to deciding on the type of anesthesia for your surgery, it is important to feel comfortable with the experience of your surgeon and the setting in which the surgery is performed. For an upper eyelid lift and face-neck lift, I generally do not use a general anesthetic. I offer my patients a choice between local anesthetic with oral (pill) sedation or local anesthetic with i.v. sedation which requires an anesthesiologist. While there is certainly more expense with an... more
Gregory J. Vipond, MD

Pasadena Facial Plastic Surgeon
+1

"best" anesthetic for facial rejuvenation

Dear Carrie Anne, Both choices have some attendant risks.  If your surgeon feels comfortable that you are a good candidate for IV or oral sedation then the choice is yours.  One difference between IV sedation and oral sedation is the level or depth of sedation which can safely be achieved while some local anesthetic is injected.  Properly chosen oral sedatives can give varying degrees of amnesia to the entire process.  This makes the option of oral sedation... more
Craig Harrison, MD

Tyler Plastic Surgeon
+1

Facelift and eyes

If you were just having the upper eyelids done( skin only) I would say local is fine. But with face work, I would only do it with sedation as a minimum.
Steven Wallach, MD

Manhattan Plastic Surgeon
+1

Facelift, Blepharoplasty with Oral sedation

I think saving money is the wrong driver to choose modes of anesthesia. More important is that you choose what you feel most comfortable with. Most surgeons do it"one way" only. If you have a choice then consider pros and cons and your own preference. Having said this, sedation with local anesthesia is my preferred (and only) way of doing facial rejuvenation surgery including facelift, necklift, eyelid lifts, facial implants etc. The sedation can be administered by mouth, IV or... more
Frank P. Fechner, MD

Worcester Facial Plastic Surgeon

www.drfechner.com

+1

Local Anesthetic w/Oral Sedation for Facelift

There are two things to consider here. First is safety. Although the Blepharoplasty and Facelift can be done under Local Anesthetic w/Oral Sedation, and it is safe to do so most of the time, the reason to have an Anesthesiologist is for added safety, just in case you have a problem during surgery. I, personally, would not have these procedures done without an Anesthesiologist. In fact, I had less done using one. The second issue is whether you will be comfortable enough with Local Anesthetic... more
Robert T. Buchanan, MD

Highlands Plastic Surgeon
+1

Facelift under local and oral sedation

Hi, Yes this is a safe way to have a facelift. Remember its the hands of your surgeon that make the surgery itself safe. Oral sedation works with good local anesthesia of the area being operated on. IV sedation does increase the risk slightly but will improve your overall comfort during the procedure. Either way, its your surgeon you should feel comfortable with. Best, Dr.S.
Oleh Slupchynskyj, MD

New York Facial Plastic Surgeon

www.facechange.org

+1

Complex issue to address in this forum.

Carrie These are the issues.  IV sedation requires the presence of an anesthesiologist or nurse anesthetist.  The reason for this is that IV sedation is actually a type of general anesthesia.  This means that while the goal is to have you at a level where you are unaware of what is going on this the surgery and extremely comfortable, your anesthesia provider must be constantly vigilant to the need to support your breathing.  When you have endotracheal intubation, the... more
Kenneth D. Steinsapir, MD

Los Angeles Oculoplastic Surgeon
+1

Oral Sedation/local for Facial Rejuvenation Surgery

Oral sedation with local anesthesia may be possible for the procedures you describe, but I would suggest not optimal.  You will probably have full awareness of the procedure with oral sedation and feel multiple injections from the surgeon.  Also, if you are not comfortable , it may limit the procedure.  Most board-certified plastic surgeons experienced in this type of surgery, would probably recommend at least some type of IV sedational anesthesia with local or general... more
Stephen Delia, M.D.

Boston Plastic Surgeon
+1

Facelift under local anesthesia.

Facelift under local anesthesia is not as safe as if you have an anesthetist who is only focused on you and not surgery. Could you do it--sure--I would spend the extra money and be safe.
Toby Mayer, MD

Beverly Hills Facial Plastic Surgeon
+1

IV vs Oral sedation for facial surgery

IV sedation is slightly riskier when deeper planes of anesthesia are desired due to loss of protective reflexes. On the other hand if you happen to have a life threatening emergency such as a heart attack or arrythmia during surgery, you would be much likelier to recover due to the presence of an anesthesiologist or a nurse anesthetist in the room. If you can afford it, choose IV sedation. You will be much more comfortable.
Peter T. Truong, MD

Fresno Oculoplastic Surgeon

www.facialsurgerydr.com

+1

You get what you pay for.

In one case, you will be awake and feel pain ( oral meds with local anesthesia) in the other case you will be monitored by a physician and given enough drugs where you should not feel any pain. Your choice. If I were having surgery, I would use an anesthesiologist and have no pain.
William B. Rosenblatt, MD

New York Plastic Surgeon

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