Can you really perform a SMAS lower face and necklift as an in-office procedure with just a local anesthetic?
Doctor Answers (20)
SMAS facelifts under straight local anesthesia, no thank you
It is amazing how anxious even the calmest patient becomes on their day of surgery, even for a tiny mole removal. It is a truly rare person who could have a real facelift done completely comfortably under straight local. So, the best plan is not to look for someone who will do this if you ask but to go to the very best facelift surgeon, ask how they prefer to do it and why, and let them do their thing and take great care of you. It is your FACE and needs to be done right, once.
True Facelift under Local Anesthesia
Local Anesthesia Facelift
First, a true facelift, not some sort of "mini" version is an extensive operation that takes at least two hours. I usually spend 2.5 to 3 hours on a lower facelift. This can seem like a very long time while you lay there.
Second, the infiltration of the local anesthetic is painful. In other words, it is a lot of shots to get you numb at the beginning, but it is definitely do-able and it only takes about 5 minutes. With some gentleness and a few tricks, it doesn't hurt that much.
Third, just because you are not under anesthesia, a proper operating room is still a must. A facelift should only be done in a properly accredited operating room regardless of anesthesia. The facility should be certified by either AAAHC, AAAASF, or JCAHO.
Having said that, I offer all of my patients the option of local anesthesia. Not surprisingly, I get very few takers. But I still do sometimes.
I perform the vast majority of my facelifts with the patient under IV sedation. This is a strong sedation that keeps you asleep, but you still breath under your own power without a tube in your lungs or gas anesthesia. I consider it to have most of the best qualities of local and general anesthesia while avoiding most of the undesirable issues.
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Can you do it? Yes. Would I recommend it to my Mother? No
Samir Shureih MD. FACS
Facelift under Local Anesthesia
Can or should?
A SMAS facelift means different things to different patients and surgeons. I know that may seem surprising but its true. If a SMAS facelift means the SMAS layer is elevated and released then the procedure should be performed with IV sedation or even a general anesthetic in some cases. The person's health, age, anxiety level, and areas needing improvement all need to be considered.
Through the years I have found most patients under-estimate their true anxiety level (its usually higher than they think especially when it comes time to do the procedure). The increased anxiety level can affect many important parameters, such as blood pressure; it increases which is not good.
Additionally, it may sounds like "less" of a procedure or "less major" when a surgeon or business suggests only local anesthesia but IV sedation (twilight, conscious sedation) and general anesthesia are both very, very safe and provide a better and safer experience for the patient, in my opinion. An additional reason for the higher safety is that to have IV sedation or a general anesthetic the procedure must be done in an accredited facility, which meets certain standards for safety and sterility. In office procedures do not have or meet these standards.
I hope this helps.
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.