4 Benefits of Having an Awake Facelift

Facelifts have long been a transformative solution in cosmetic surgery, and they’re only getting more popular. According to The American Society of Plastic Surgeons’ 2022 statistics report, there was an 8% increase in the number of procedures performed year over year. Alongside this overall growth, the aesthetics field has seen innovative approaches, like awake deep plane facelifts, gain attention for setting new standards. “In my practice, I probably do about 70% awake deep plane facelifts, and the remaining 30% are done under twilight or IV sedation,” says Dr. Mansher Singh, a board-eligible plastic surgeon in New York City.

Staying awake during a facelift may sound daunting, but it’s not what you think—you’re aware of what’s happening but very comfortably drowsy. This technique primarily uses local anesthesia (to limit feelings of pain) in conjunction with oral sedation (also known as pill sedation). 

“We typically just give some Valium. The patients get pretty relaxed, but they’re not knocked out,” explains Dr. Raymond E. Lee, a board-certified facial plastic surgeon in Newport Beach, California. Oral sedation involves administrating benzodiazepines, which reduce activity in the parts of the brain responsible for fear and anxiety, creating a calm and relaxed state without leaving the patient unconscious. In contrast, twilight anesthesia produces similar results but is often administered via an IV by an anesthesiologist. So while the awake option differs significantly from general anesthesia (where intubation is necessary), it’s also less invasive than twilight sedation.

Even in the best hands, all surgery carries inherent risks. This is especially true for patients undergoing complex, technically laborious surgeries such as deep plane facelifts (which can take four to five hours to perform) under general anesthesia. “A lot of patients are afraid of general anesthesia, for good reason. Some research shows that having multiple surgeries under general anesthesia over a lifetime can lead to cognitive decline or memory loss, especially in the older population,” says Dr. Lee. A 2019 review published in the Journal of Anesthesia found that “cognitive disturbance” was commonly seen in elderly patients following surgery under general anesthesia. The incidence of postoperative cognitive dysfunction (POCD), a state of cognitive dysfunction involving short-term and long-term memory, mood, and brain function, was reported to affect 26% of patients over the age of 60 in the first postoperative week. 

Dr. Singh says that despite the rarity of risks related to general anesthesia in healthy younger patients, there are still advantages to choosing an awake deep plane facelift. “Any anesthesia method these days is [generally] safe, but the risk is even lower with awake facelifts. You have few medications in your system, which makes it inherently safer,” he says.

Ahead, the doctors break down four benefits of the awake facelift. 

1. Enhanced safety and comfort

Comfort and safety probably are key aspects of the awake facelift experience for suitable candidates. “The combination of reduced medication and the absence of general anesthesia ensures the patients remain comfortable and less anxious throughout the procedure,” says Dr. Lee. This approach is particularly beneficial for those who meet the criteria for an awake facelift.

Dr. Singh emphasizes the advantages, especially for first-time patients. “Primary facelifts with mild to moderate aging, typically in patients in their 40s to 50s, are ideal for this technique. The absence of general anesthesia and reliance on local anesthesia and oral sedation make it a safer and more comfortable option for these patients.”

Still, awake facelifts aren’t a one-size-fits-all option. Certain health conditions or personal factors can influence whether this approach is appropriate. “Patients with significant cardiovascular issues or severe anxiety, or those who have been less responsive to local anesthesia in the past, might not be the best candidates for this approach,” says Dr. Singh. Additionally, Dr. Lee notes that “patients with very high anxiety levels or a low tolerance for discomfort might find the experience challenging.” Secondary surgeries can also be more complex due to scar tissue from previous procedures, so they’re not always ideal for an awake approach.

2. Cost-effectiveness

On average, a facelift can set you back $12,625, according to RealSelf data from patients who underwent the surgery, but the price can go up as high as $200,000, depending on where you live and how well known the plastic surgeon is. Opting to undergo an awake facelift will cut down on costs, since patients will not have to pay for the services of an anesthesiologist, explains Dr. Singh. “It’s a little bit cheaper than IV sedation or general anesthesia because there’s no cost for an anesthesiologist, which you pass on to the patient,” he says. 

In addition, patients may also incur additional savings, since some doctors will perform an awake deep plane facelift in their office rather than a surgical center or hospital, says Dr. Lee. “A local-anesthesia facelift—awake facelift—can be performed in the office. Anesthesia is typically about $1,500, and the fee for a surgical center might be another $1,800. So you’re looking at over $3,000 in savings,” he says.

3. Quicker, easier recovery

A faster recovery can be an enticing factor for many patients. Both a deep plane facelift done under general anesthesia and one done under local will take the same time for the body to recover (approximately two weeks before patients can return to work and perform less strenuous physical activities; full results will usually take several months to a year to appear), but the recovery process from the effects of anesthesia is generally more pleasant and quicker with the awake approach. After undergoing general anesthesia, patients often need to manage side effects such as nausea, chills, and vomiting—which, Dr. Singh cautions, is particularly important to avoid, since it can rupture blood vessels in the face and set back healing. Uncomfortable symptoms, like constipation and a sore throat from the breathing tube used during surgery, are common. To alleviate these issues, doctors usually recommend stool softeners and throat lozenges, which typically help ease these symptoms within a few days.

Patients who choose an awake deep plane facelift also tend to experience less bruising and swelling, says Dr. Singh. This advantage is likely due to the minimal use of medications during the awake procedure compared to those required with general anesthesia.

Anecdotally, many doctors also discuss the fact that a large proportion of patients experience feelings of sadness or depression following surgery, sometimes referred to as postoperative depression. While some patients may still experience this phenomenon, others report feeling better when they don’t have to manage the side effects of general anesthesia, says Dr. Lee. “Mentally and emotionally, they just feel like they have a quicker recovery,” he says.

4. Tailored results

The choice between undergoing a facelift under general anesthesia versus awake isn’t solely about comfort; it’s also about precision. Both methods lead to similar results, yet awake surgery offers certain advantages, particularly when combining facelifts with complementary procedures like,a neck lift, blepharoplasty, lasers, or fat transfer, according to Dr. Singh. “When the patient is awake, they can look up for 20 minutes, which makes neck dissection so much easier for me,” he says. This active participation allows for more precise sculpting, especially in delicate areas like the neck.

Dr. Lee stresses the intricacy and mastery necessary to perform these procedures. “There’s a lot of art to doing a facelift under local. It’s actually not easily performed. You need to get patients in the right mood. The right music has to be playing, there has to be a really soothing, trusting environment,” he says. Patients deciding whether to undergo an awake facelift should weigh the benefits against their own individual comfort levels and medical considerations.